Risk factors for lateral lymph node metastasis in T1 stage papillary thyroid carcinoma
Fan et al. presented a retrospective cohort study analyzing the risk factors for lateral lymph node metastasis (LLNM) in T1 stage papillary thyroid carcinoma (PTC). The researchers conducted a retrospective cohort analysis of 3,332 patients who underwent initial thyroidectomy at West China Hospital, Sichuan University between June 2017 and February 2023 (1). The primary aim was to identify risk factors associated with LLNM in PTC patients. The main conclusions of the study indicate that the risk of LLNM in T1 stage PTC patients is influenced by several factors, including male gender, upper lobe tumor location, larger tumor volume, and multifocality, while age, maximum tumor diameter, bilaterality, and duration of active surveillance were not significantly associated with LLNM risk. Additionally, the study found that gender, tumor location, and multifocality elevated LLNM risk specifically in the T1a subgroup, whereas in the T1b subgroup, tumor location, dimensions, and multifocality were significant predictors, with gender having a marginal effect. While this study provides valuable insights into the risk factors for LLNM in T1 stage PTC, it is important to acknowledge that there may be some limitations which need to be addressed.
Firstly, the retrospective nature and single-center design of the study pose inherent challenges. This limits the generalizability of the findings and may introduce selection bias. Retrospective studies rely on existing data, which may not have been collected with the current research question in mind. This can introduce biases, such as selection bias or information bias, affecting the accuracy and reliability of the findings (2). Conducting prospective, multicenter studies with larger sample sizes would improve the generalizability of the findings and reduce selection bias.
Secondly, as a single-center study, the results may lack generalizability. Differences in patient characteristics, surgical techniques, and pathological evaluation across centers can significantly impact the outcomes (3). Therefore, the findings of this study may not be applicable to other populations or settings. Additionally, the study lacks uniformity in tumor location assessment and a separate analysis for different types of lymph node metastasis. Performing subgroup analyses for different types of lymph node metastasis (e.g., central vs. lateral) could provide more nuanced insights into risk factors and management strategies.
Thirdly, the study did not report long-term outcomes. While it provides valuable insights into the risk factors for LLNM in T1 stage PTC, the lack of long-term data limits our understanding of the prognostic significance of these findings. Conducting studies with extended follow-up periods would allow for a more comprehensive evaluation of long-term outcomes and recurrence rates.
Fourthly, the study did not include molecular markers in its analysis. Molecular markers have been shown to influence tumor progression and metastasis in PTC (4,5). The exclusion from the study may have limited the comprehensiveness of the analysis.
Lastly, although the authors adjusted for several variables in their multivariate analysis, there may still be unmeasured confounders that could potentially influence the results. These unmeasured factors could have an impact on the accuracy and validity of the conclusions drawn from the study.
In summary, the study provides valuable insights into the risk factors for LLNM in T1 stage PTC, but the limitations mentioned above should be taken into consideration when interpreting the findings. Future prospective, multi-center studies with long-term follow-up and incorporating molecular markers may help to further clarify the prognostic significance of LLNM in PTC.
Acknowledgments
Funding: None.
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Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://gs.amegroups.com/article/view/10.21037/gs-24-143/coif). The authors have no conflicts of interest to declare.
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