Authors
H Huang, G N Ge, Z F Kuang, C J Zhang, G Chen, X Q Xu, Y Cao, Y Zhao, J J Yao, Y Xia, X Y Li
Published in
Zhonghua wai ke za zhi [Chinese journal of surgery]. Volume 64. Issue 12. Pages 1307-1315. Oct 29, 2026. Epub Oct 29, 2026.
Abstract
Objectives: To investigate the correlation between preoperative serum thyroglobulin(Tg) levels and papillary thyroid carcinoma(PTC) tumor burden, and to evaluate Tg's diagnostic value for cervical lymph node metastasis in PTC. Methods: This is a retrospective case series study. The clinicopathological data of 1 585 patients with PTC who underwent initial surgical treatment at the Department of General Surgery, Peking Union Medical College Hospital between November 2013 and December 2020 were retrospectively analyzed. There were 563 male and 1 022 female patients, aged (41.1±10.5)years (range: 15 to 74 years). All included patients were thyroglobulin antibody(TgAb)-negative preoperatively and had no concomitant benign thyroid disease. A stratified multivariate linear regression model was used to analyze the weight of different tumor burden dimensions in explaining log-transformed Tg (LnTg). Block-specific analysis was used to evaluate the independent explanatory contribution of each dimension to LnTg. Restricted cubic spline (RCS) analysis was performed to assess both overall and nonlinear associations between tumor burden parameters and LnTg. Receiver operating characteristic (ROC) curves were constructed to determine the optimal cutoff value of preoperative Tg for predicting lateral cervical lymph node metastasis, and its diagnostic performance was evaluated both alone and in combination with preoperative ultrasound findings. Results: Univariate analysis showed statistically significant differences in serum Tg levels among patients with different tumor numbers (1 vs. 2 vs. ≥3), diffrent maximum tumor diameter (≤1 cm vs. >1-2 cm vs. >2 cm), different degrees of capsular invasion (no invasion vs. capsular invasion only vs. extraglandular invasion), different total numbers of metastatic lymph nodes (0 vs. 1-5 vs. ≥6), and with or without central or lateral cervical lymph node metastasis (all P<0.01). Stratified regression analysis showed that primary tumor burden contributed most to the independent explanation of Tg (partial R²=0.130, P<0.01), followed by lymph node burden (partial R²=0.029, P<0.01). Restricted cubic spline analysis confirmed that maximum tumor diameter, total number of metastatic lymph nodes and number of metastatic lateral cervical lymph nodes were correlated with LnTg (overall effect P<0.01), and the former two showed no clear nonlinear trend. The area under the receiver operating characteristic curve of preoperative Tg for predicting lateral neck lymph node metastasis was 0.742 (95%CI: 0.699 to 0.782), with an optimal cutoff value of 23.8 ng/ml (Roche). At this cutoff value, the negative predictive value (NPV) for predicting lateral cervical lymph node metastasis was 93.4%, slightly lower than that of ultrasound (97.5%). When combined with preoperative ultrasound, the positive predictive value (PPV) reached 94.0%, while a favorable NPV (93.5%) was maintained. Its NPV for predicting extensive lymph node metastasis (≥6 nodes) was 89.4%, slightly lower than that of ultrasound (91.5%). Conclusions: In PTC patients with negative TgAb and no concomitant benign thyroid diseases, preoperative serum Tg levels are correlated with tumor burden indicators such as the maximum tumor diameter and the number of metastatic lymph nodes. When 23.8 ng/ml (Roche assay) is adopted as the cutoff value, preoperative serum Tg shows a high NPV for predicting lateral cervical and extensive lymph node metastasis. Moreover, preoperative Tg can improve the PPV of ultrasound for predicting lateral cervical lymph node metastasis, thereby assisting preoperative ultrasonographic evaluation of lateral cervical lymph node metastasis.
PMID:
42951853
Bibliographic data and abstract were imported from PubMed on 29 Oct 2026.
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