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Abstract：
UNASSIGNED: Active surveillance (AS) has become an alternative treatment approach for papillary thyroid microcarcinoma (PTMC). The purpose of this study is to uncover the clinicopathological factors associated with high-risk nodal disease in order to select proper candidates for AS of PTMC.
UNASSIGNED: We retrospectively reviewed 5,329 patients with PTMC without extrathyroidal extension (ETE) who underwent thyroidectomy with central compartment neck dissection (CCND) between 2007 and 2021 at Seoul St. Mary\'s Hospital. Patients with more than five metastatic lymph nodes (MLNs) (higher-risk N1 disease) and/or lateral neck node metastases (N1b disease) were defined as having high-risk nodal disease. The clinicopathological factors associated with high-risk nodal disease were analyzed.
UNASSIGNED: A total of 415 (7.8%) patients had higher-risk N1 disease. These patients were younger on average, included a higher proportion of males, and had a larger tumor size and more frequent capsular invasion and multifocality compared with other patients. For the tumor size, a cutoff value of 0.65 cm was the best predictor of nodal risk groups. In a multivariate analysis, the independent risk factors associated with higher-risk N1 disease were younger age, male sex, tumor size >0.65 cm, and the presence of capsular invasion and/or multifocality. A total of 246 (4.6%) patients had N1b disease at initial diagnosis. In a multivariate analysis, the independent risk factors associated with N1b disease were younger age, male sex, tumor size >0.65 cm, and the presence of capsular invasion and/or multifocality.
UNASSIGNED: Young age, male sex, tumor size >0.65 cm, and presence of capsular invasion and/or multifocality can be considered risk factors for high-risk nodal disease in PTMC. Therefore, cautious observation is necessary for AS of patients with these characteristics.
UNASSIGNED: We retrospectively reviewed 5,329 patients with PTMC without extrathyroidal extension (ETE) who underwent thyroidectomy with central compartment neck dissection (CCND) between 2007 and 2021 at Seoul St. Mary\'s Hospital. Patients with more than five metastatic lymph nodes (MLNs) (higher-risk N1 disease) and/or lateral neck node metastases (N1b disease) were defined as having high-risk nodal disease. The clinicopathological factors associated with high-risk nodal disease were analyzed.
UNASSIGNED: A total of 415 (7.8%) patients had higher-risk N1 disease. These patients were younger on average, included a higher proportion of males, and had a larger tumor size and more frequent capsular invasion and multifocality compared with other patients. For the tumor size, a cutoff value of 0.65 cm was the best predictor of nodal risk groups. In a multivariate analysis, the independent risk factors associated with higher-risk N1 disease were younger age, male sex, tumor size >0.65 cm, and the presence of capsular invasion and/or multifocality. A total of 246 (4.6%) patients had N1b disease at initial diagnosis. In a multivariate analysis, the independent risk factors associated with N1b disease were younger age, male sex, tumor size >0.65 cm, and the presence of capsular invasion and/or multifocality.
UNASSIGNED: Young age, male sex, tumor size >0.65 cm, and presence of capsular invasion and/or multifocality can be considered risk factors for high-risk nodal disease in PTMC. Therefore, cautious observation is necessary for AS of patients with these characteristics.
摘要：
■主动监测（AS）已成为甲状腺乳头状微小癌（PTMC）的替代治疗方法。这项研究的目的是揭示与高危淋巴结疾病相关的临床病理因素，以便选择合适的PTMCAS候选人。
■我们回顾性分析了2007年至2021年在首尔圣玛丽医院接受甲状腺切除术伴中央室颈清扫术(CCND)的5,329例无甲状腺外扩张(ETE)的PTMC患者。具有五个以上转移性淋巴结（MLN）（高风险N1疾病）和/或颈外侧淋巴结转移（N1b疾病）的患者被定义为具有高风险淋巴结疾病。分析与高危淋巴结疾病相关的临床病理因素。
■共有415名（7.8%）患者患有较高风险的N1疾病。这些患者平均年轻，包括较高比例的男性，与其他患者相比，肿瘤体积更大，包膜侵犯和多病灶更频繁。对于肿瘤的大小,截止值0.65cm是淋巴结风险组的最佳预测因子.在多变量分析中，与高危N1疾病相关的独立危险因素是年龄较小，男性,肿瘤大小>0.65厘米，以及存在包膜浸润和/或多灶性。共有246例（4.6%）患者在初始诊断时患有N1b疾病。在多变量分析中，与N1b疾病相关的独立危险因素是年龄较小，男性,肿瘤大小>0.65厘米，以及存在包膜浸润和/或多灶性。
■年轻，男性,肿瘤大小>0.65厘米，包膜浸润和/或多灶性的存在可被认为是PTMC高危淋巴结疾病的危险因素。因此,对于具有这些特征的AS患者，谨慎观察是必要的。
■我们回顾性分析了2007年至2021年在首尔圣玛丽医院接受甲状腺切除术伴中央室颈清扫术(CCND)的5,329例无甲状腺外扩张(ETE)的PTMC患者。具有五个以上转移性淋巴结（MLN）（高风险N1疾病）和/或颈外侧淋巴结转移（N1b疾病）的患者被定义为具有高风险淋巴结疾病。分析与高危淋巴结疾病相关的临床病理因素。
■共有415名（7.8%）患者患有较高风险的N1疾病。这些患者平均年轻，包括较高比例的男性，与其他患者相比，肿瘤体积更大，包膜侵犯和多病灶更频繁。对于肿瘤的大小,截止值0.65cm是淋巴结风险组的最佳预测因子.在多变量分析中，与高危N1疾病相关的独立危险因素是年龄较小，男性,肿瘤大小>0.65厘米，以及存在包膜浸润和/或多灶性。共有246例（4.6%）患者在初始诊断时患有N1b疾病。在多变量分析中，与N1b疾病相关的独立危险因素是年龄较小，男性,肿瘤大小>0.65厘米，以及存在包膜浸润和/或多灶性。
■年轻，男性,肿瘤大小>0.65厘米，包膜浸润和/或多灶性的存在可被认为是PTMC高危淋巴结疾病的危险因素。因此,对于具有这些特征的AS患者，谨慎观察是必要的。
