Risk of lymph nodes metastasis related to reproductive factors in PTC: Female gender

Abstract Objective: Female reproductive factors have been associated with the development of papillary thyroid carcinoma (PTC), but their relationship with the progression is not clear.Therefore, this study focused on the relationship between female PTC progression and reproductive factors to improve individualized diagnosis and treatment options for female PTC. Methods: The clinicopathologic data of 1828 patients with PTC who were diagnosed in the Department of Western Campus of the Fourth Affiliated Hospital of Hebei Medical University from January 2015 to December 2019 were retrospectively analyzed. Results : Of 1828 women with PTC, 903 (49.4%) developed lymph node metastasis(LNM) during the first operation. Logistic regression analysis showed that the incidence of cervical lymph node metastasis (CLNM) was lower (OR = 0.414, 95% CI: 0.266 – 0.645) and the incidence of cervical and lateral lymph node metastasis (CLNM + LLNM) was also lower (OR = 0.346, 95% CI: 0.187 – 0.642) in those with reproductive history than in those without reproductive history. After propensity score matching was used to eliminate all potential positive confounders at baseline, the only outcome measure was LNM, and the results showed that the incidence of LNM was still lower in those with reproductive history than in those without reproductive history overall after excluding each confounding factor, and the difference was statistically significant ( P = 0.049), and the positive rate in CLNM was mainly affected ( P = 0.018). Conclusion: Female reproductive factors exert a significant influence on the occurrence of lymph node metastasis in PTC. For nulliparous women, as well as women > 55 years of age at menopause, early surgery is recommended if multifocal, bilateral, and extraglandular invasion is present, and ipsilateral central dissection is recommended actively, and if CLNM has been confirmed, lateral cervical lymph nodes are recommended to be vigilant and actively managed.