Is there a predictive value of systemic inflammatory parameters and prognostic nutritional index in the detection of lymphatic metastases in papillary thyroid cancers?

Abstract

This study aimed to assess the predictive value of systemic inflammatory parameters and the prognostic nutritional index (PNI) in identifying lymphatic metastases in papillary thyroid cancers (PTC). PTCs, characterized by their in dolent nature and favorable prognosis, frequently disseminate to cervical lymphnodes, impacting recurrence and prognosis. However, the preoperative identification rate of cervical lymphnode metastases ranges from 20% to 75%, necessitating supplemental examinations for precise detection and surgical planning. A retrospective analysis of 441 thyroidectomy cases, encompassing 272 PTC patients, was conducted. Patients were categorized into two cohorts: 221 lacked lymphnode metastases, while 51 exhibited lymphatic metastases. Parameters including age, gender, systemic inflammatory markers derived from hemogram tests, serum albumin levels, and postoperative histopathology findings were scrutinized to evaluate the predictive potential of systemic inflammatory parameters and PNI in discerning between the two cohorts. The findings revealed that neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) values bore statistically significant predictive capacity (p<0.05) in preoperatively detecting cervical lymphnode metastases in PTC. Receiver operating characteristic (ROC) curves delineated the efficacy of NLR, PLR, and SII in prognostication. NLR exhibited an area under the curve (AUC) value of 0.932 (95% CI, 0.902-0.962; p<0.001), while PLR yielded an AUC value of 0.638 (95% CI, 0.555-0.721; p=0.002). SII analysis yielded an AUC value of 0.798 (95% CI, 0.736-0.861; p<0.001). Conversely, the prognostic nutritional index (PNI) demonstrated meager predictive utility, registering an AUC value of 0.192 (95% CI, 0.124-0.260; p<0.001), positioning below the reference line on the ROC curve. In conclusion, this study under scores NLR's utility in identifying cervical lymphnode metastases in PTC. While PLR and SII evince some association with lymphnode metastasis detection, their predictive efficacy remains constrained. Additionally, despite statistical significance, PNI exhibited in efficacy in forecasting lymphnode metastases.