Predictive factors of metastasis in lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma.
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OBJECTIVE: The objective of this study was to determine the risk factors associated with lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in patients with papillary thyroid carcinoma (PTC). METHOD: A total of 1381 patients diagnosed with PTC who underwent right or total thyroidectomy were included in this retrospective study. The relationship between clinicopathological variables and metastasis to lymph nodes posterior to the right recurrent laryngeal nerve was evaluated using both univariate and multivariate analyses. RESULTS: Right-sided Central Lymph Node (CLN) positivity was detected in 42.8% (591/1381) of patients.The metastasis rates for LN-arRLN and LN-prRLN were 36.5% (504/1381) and 17.89% (247/1381), respectively. Simultaneous metastasis to both LN-arRLN and LN-prRLN was present in 11.59% (160/1381) of patients. Furthermore, among patients without LN-arRLN metastasis, the metastasis rate for LN-prRLN was 9.8% (87/887). Factors associated with an increased risk of LN-arRLN metastasis include gender, age, maximum tumor diameter, microcalcification, thyroid capsule invasion, prelaryngeal lymph node metastasis, pretracheal lymph node metastasis, and lateral neck lymph node metastasis. Furthermore, maximum tumor diameter, proximity to the posterior medial capsule, prelaryngeal lymph node metastasis, LN-arRLN metastasis, left central lymph node metastasis, and lateral neck lymph node metastasis were identified as independent predictors of LN-prRLN metastasis(P<0.001). CONCLUSION: In conclusion, LN-prRLN metastasis is relatively common in patients with PTC. For those undergoing central lymph node dissection (CLND), LN-prRLN dissection should be considered when high-risk features are present, including maximum tumor diameter > 1 cm, proximity to the posterior medial capsule, prelaryngeal lymph node metastasis, LN-arRLN metastasis, left central lymph node metastasis, and lateral neck lymph node metastasis. CLINICAL TRIAL NUMBER: Not applicable.