Risk Factors for Lymph Node Skip Metastasis in Thyroid Papillary Carcinoma: A Retrospective Study

Objective: To perform a risk analysis for lymph node skip metastasis in thyroid papillary carcinoma and provide references for prognostic predictions and treatment decisions. Methods All surgical papillary thyroid carcinoma (PTC) cases with lateral lymph node metastasis at the Third Affiliated Hospital of Sun-Yat-Sen University were reviewed from July 1st, 2014, to July 1st, 2020. Patients were divided into two groups based on central lymph node metastasis. Analyzed factors included clinical and pathological characteristics. Univariate and multivariate logistic regression analyses were used to detect lateral lymph node skip metastasis risk factors. Results Multivariate logistic regression analysis found that older age(>46.5 years, P = 0.001, OR = 1.064), tumor size less than 10mm༈mean ± SD ≤ 10mm/>10mm, P = 0.001, OR = 8.983), and BRAF gene mutations (P = 0.035, OR = 6.484) were associated with skip lymph node metastasis. However, skip metastasis was not associated with tumor location, multiplicity, bi-laterality, vascular invasion, lymphatic invasion, perineural invasion, or autoimmune thyroid disease. Conclusion Lateral lymph node detection should be given attention for all patients with PTC, especially for cases in older patients, tumor size smaller than 10mm, extrathyroidal extension, and BRAF gene mutations.