Comparison of total thyroidectomy and lobectomy for intermediate-risk papillary thyroid carcinoma with lateral lymph node metastasis: a systematic review and meta-analysis
Bibliographic record
Abstract
BACKGROUND: The 2015 American Thyroid Association guidelines recommend total thyroidectomy (TT) followed by radioactive iodine (RAI) therapy as the primary treatment modality for intermediate-risk papillary thyroid carcinoma (PTC) patients with lateral lymph node metastasis (LLNM). However, the supporting evidence remains insufficient. The clinical superiority of TT versus lobectomy (LT) in this patient population remains unclear, and the optimal surgical approach for intermediate-risk PTC with LLNM continues to be debated. AIM: This meta-analysis examined the clinical superiority of TT versus LT for intermediate-risk PTC with unilateral LLNM. METHODS: This PRISMA/AMSTAR-compliant meta-analysis (PROSPERO: CRD42023410775) evaluated recurrence-free survival (RFS) in intermediate-risk PTC with unilateral LLNM. Systematic searches of PubMed, Web of Science, and Cochrane Library (2004-2024) combined Medical Subject Heading terms and title/abstract: ("papillary thyroid carcinoma" OR "papillary thyroid cancer" OR "PTC") AND ("lateral cervical lymph node metastasis" OR "lateral neck lymph node metastasis" OR "lateral lymph node metastasis" OR "lateral cervical nodal metastasis" OR "N1b") AND ("thyroidectomy" OR "total thyroidectomy" OR "lobectomy"). Two investigators independently extracted data on surgical outcomes, adjuvant RAI therapy, and RFS metrics, with quality assessed via Newcastle-Ottawa Scale. Prespecified subgroup analyses examined RAI utilization and surgical extent impacts. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were calculated using Review Manager 5.3, prioritizing adjusted HR. Heterogeneity was assessed via I2 statistics. RESULTS: Among 609 initially identified references, 8 studies met the inclusion and exclusion criteria, comprising 2462 intermediate-risk PTC patients with unilateral LLNM. Of these, 53.3% (1313/2462) underwent TT, and 46.7% (1149/2462) underwent LT. Compared with the TT group, LT showed no statistically significant difference on RFS (HR = 1.08, 95% CI 0.83-1.40, P = 0.56). In subgroup analyses: Compared with TT + RAI, LT showed no significant difference in RFS (HR = 0.66, 95% CI 0.40-1.08, P = 0.10); Compared with TT + RAI, LT or TT alone showed no significant difference in RFS (HR = 0.65, 95% CI 0.41-1.03, P = 0.07); Compared with TT alone, LT showed no significant difference in RFS (HR = 1.16, 95% CI 0.63-2.12, P = 0.64); Compared with TT + RAI, TT alone showed no significant difference in RFS (HR = 0.87, 95% CI 0.42-1.81, P = 0.37). CONCLUSION: For intermediate-risk PTC patients with isolated unilateral LLNM, TT, and LT demonstrate comparable oncological outcomes in terms of RFS. Unilateral LLNM alone should not constitute an absolute indication for TT. When no additional high-risk features are present, LT may serve as a preferable alternative to optimize quality of life while maintaining oncological safety.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.036 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".