{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:36:46Z","timestamp":1787020606159,"version":"build-2736575974"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T00:00:00Z","timestamp":1760400000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Natural Science Foundation of Guangxi Province","award":["2023GXNSFAA026037"],"award-info":[{"award-number":["2023GXNSFAA026037"]}]},{"name":"Guangxi Medical and Health Appropriate Technology Development and Application Project","award":["S2022062"],"award-info":[{"award-number":["S2022062"]}]},{"name":"Guangxi Zhuang Autonomous Region Health Commission self-funded research project","award":["Z20210898"],"award-info":[{"award-number":["Z20210898"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Surg Onc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Metastasis to lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PTC) presents significant surgical challenges due to its deep anatomical location and association with disease recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify risk factors for LN-prRLN metastasis and develop a validated prediction model for clinical decision-making.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective analysis of 341 PTC patients underwent LN-prRLN dissection (May 2022\u2013September 2024) at the First Affiliated Hospital of Guangxi Medical University was conducted. Clinicopathological characteristics were compared between metastasis-positive and negative groups. Independent risk factors were identified through univariate and multivariate logistic regression and utilized to construct a nomogram. Model performance was assessed using Receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Male (odds ratio\u2009=\u20092.670, 95%CI:1.094\u20136.516), Tumor diameter (odds ratio\u2009=\u20091.931, 95%CI:1.140\u20133.270), Multifocality (odds ratio\u2009=\u20093.658, 95%CI:1.251\u201310.692), LN-arRLN metastasis (odds ratio\u2009=\u20091.340, 95%CI:1.122\u20131.602), Lateral lymph node metastasis (odds ratio\u2009=\u20097.815, 95%CI:2.857\u201321.379), Extrathyroidal extension (OR\u2009=\u20093.627, 95%CI:1.133\u201311.611) were identified as the independent risk factors for LN-prRLN metastasis. The nomogram demonstrated excellent discrimination (AUC: training cohort\u2009=\u20090.889; validation cohort\u2009=\u20090.858). The calibration curves demonstrated good concordance between predicted probabilities and the actual observed probabilities. The DCA curve indicates robust clinical utility for the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study extends prior research by identifying additional independent risk factors, the model evaluation results indicated satisfactory predictive performance, facilitates individualized surgical planning to balance therapeutic efficacy against procedural risks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12957-025-04012-9","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T15:45:22Z","timestamp":1760456722000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk factors and prediction model for lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma"],"prefix":"10.1186","volume":"23","author":[{"given":"Xiaowen","family":"Fang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jihao","family":"Qin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenxi","family":"Liang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueyu","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie-Hua","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,14]]},"reference":[{"issue":"1","key":"4012_CR1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.jncc.2024.01.006","volume":"4","author":"B Han","year":"2024","unstructured":"Han B, Zheng R, Zeng H, et al. Cancer incidence and mortality in China, 2022. J Natl Cancer Center. 2024;4(1):47\u201353.","journal-title":"J Natl Cancer Center"},{"issue":"5","key":"4012_CR2","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1097\/CM9.0000000000002108","volume":"135","author":"C Xia","year":"2022","unstructured":"Xia C, Dong X, Li H, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J (Engl). 2022;135(5):584\u201390.","journal-title":"Chin Med J (Engl)"},{"issue":"4","key":"4012_CR3","doi-asserted-by":"publisher","first-page":"625","DOI":"10.3390\/biom10040625","volume":"10","author":"D Pamedytyte","year":"2020","unstructured":"Pamedytyte D, Simanaviciene V, Dauksiene D, et al. Association of microrna expression and BRAF(V600E) mutation with recurrence of thyroid cancer. Biomolecules. 2020;10(4):625.","journal-title":"Biomolecules"},{"issue":"1","key":"4012_CR4","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1111\/cen.12583","volume":"83","author":"H Qu","year":"2015","unstructured":"Qu H, Sun GR, Liu Y, et al. Clinical risk factors for central lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis. Clin Endocrinol (Oxf). 2015;83(1):124\u201332.","journal-title":"Clin Endocrinol (Oxf)"},{"key":"4012_CR5","doi-asserted-by":"crossref","unstructured":"Jang SW, Park JH, Kim HR, et al. Recurrence risk evaluation in patients with papillary thyroid carcinoma: multicenter machine learning evaluation of lymph node variables. Cancers (Basel). 2023;15(2):550.","DOI":"10.3390\/cancers15020550"},{"issue":"9","key":"4012_CR6","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1177\/000313480507100907","volume":"71","author":"YD Podnos","year":"2005","unstructured":"Podnos YD, Smith D, Wagman LD, et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg. 2005;71(9):731\u20134.","journal-title":"Am Surg"},{"key":"4012_CR7","unstructured":"Zhang PY, Zhang B,Bu JL et al. Prospective analysis of the risk factors and clinical indications of dissection of lymph node posterior to right recurrent laryngeal nerve in 283 cases of papillary thyroid carcinoma [J]. Chin J Oncol 2014,36(2):109\u201314(in Chinese)."},{"issue":"1","key":"4012_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1089\/thy.2015.0020","volume":"26","author":"BR Haugen","year":"2016","unstructured":"Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26(1):1\u2013133.","journal-title":"Thyroid"},{"key":"4012_CR9","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.914946","volume":"13","author":"M Zhou","year":"2022","unstructured":"Zhou M, Duan Y, Ye B, et al. Pattern and predictive factors of metastasis in lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma. Front Endocrinol (Lausanne). 2022;13:914946.","journal-title":"Front Endocrinol (Lausanne)"},{"key":"4012_CR10","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/7064328","volume":"2019","author":"C Li","year":"2019","unstructured":"Li C, Xiang J, Wang Y. Risk factors for predicting lymph nodes posterior to right recurrent laryngeal nerve (LN-prRLN) metastasis in thyroid papillary carcinoma: a meta-analysis. Int J Endocrinol. 2019;2019:7064328.","journal-title":"Int J Endocrinol"},{"issue":"5","key":"4012_CR11","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0177956","volume":"12","author":"YM Park","year":"2017","unstructured":"Park YM, Lee SM, Kim DW, et al. Predictive factors of right paraesophageal lymph node metastasis in papillary thyroid carcinoma: single center experience and meta-analysis. PLoS ONE. 2017;12(5):e0177956.","journal-title":"PLoS ONE"},{"issue":"12","key":"4012_CR12","doi-asserted-by":"publisher","first-page":"1309","DOI":"10.1089\/thy.2011.0170","volume":"21","author":"GL Clayman","year":"2011","unstructured":"Clayman GL, Agarwal G, Edeiken BS, et al. Long-term outcome of comprehensive central compartment dissection in patients with recurrent\/persistent papillary thyroid carcinoma. Thyroid. 2011;21(12):1309\u201316.","journal-title":"Thyroid"},{"issue":"1","key":"4012_CR13","doi-asserted-by":"publisher","first-page":"15","DOI":"10.4158\/EP-2020-0129","volume":"27","author":"J Li","year":"2021","unstructured":"Li J, He G, Tong Y, et al. A novel scoring system for the risk of papillary thyroid cancer metastases in lymph nodes posterior to the right of the recurrent laryngeal nerve. Endocr Pract. 2021;27(1):15\u201320.","journal-title":"Endocr Pract"},{"key":"4012_CR14","doi-asserted-by":"publisher","first-page":"2449","DOI":"10.2147\/CMAR.S167997","volume":"10","author":"Y Luo","year":"2018","unstructured":"Luo Y, Xu XC, Shen J, et al. Model of lymph node metastasis posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma. Cancer Manag Res. 2018;10:2449\u201355.","journal-title":"Cancer Manag Res"},{"issue":"8","key":"4012_CR15","doi-asserted-by":"publisher","first-page":"1896","DOI":"10.3390\/cancers14081896","volume":"14","author":"H Kim","year":"2022","unstructured":"Kim H, Kwon H, Moon BI. Predictors of recurrence in patients with papillary thyroid carcinoma: does male sex matter? Cancers (Basel). 2022;14(8):1896.","journal-title":"Cancers (Basel)"},{"issue":"3","key":"4012_CR16","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1016\/j.anl.2022.10.001","volume":"50","author":"P Shi","year":"2023","unstructured":"Shi P, Yang D, Liu Y, et al. A protective factor against lymph node metastasis of papillary thyroid cancer: female gender. Auris Nasus Larynx. 2023;50(3):440\u20139.","journal-title":"Auris Nasus Larynx"},{"issue":"11","key":"4012_CR17","doi-asserted-by":"publisher","first-page":"1771","DOI":"10.2217\/fon.10.127","volume":"6","author":"R Rahbari","year":"2010","unstructured":"Rahbari R, Zhang L, Kebebew E. Thyroid cancer gender disparity. Future Oncol. 2010;6(11):1771\u20139.","journal-title":"Future Oncol"},{"key":"4012_CR18","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1187825","volume":"14","author":"Y Gong","year":"2023","unstructured":"Gong Y, Zuo Z, Tang K, Xu Y, Zhang R, Peng Q, et al. Multimodal predictive factors of metastasis in lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma. Front Endocrinol (Lausanne). 2023;14:1187825.","journal-title":"Front Endocrinol (Lausanne)"},{"issue":"3","key":"4012_CR19","first-page":"200","volume":"41","author":"Sw Shan","year":"2021","unstructured":"Shan Sw, Liu CB, Wei W, et al. Evaluation of the clinical and ultrasound characteristics in the metastasis of lymph node posterior to right recurrent laryngeal nerve in papillary thyroid carcinoma[J]. J Xuzhou Med Univ. 2021;41(3):200\u20134. (in Chinese).","journal-title":"J Xuzhou Med Univ"},{"issue":"3","key":"4012_CR20","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1507\/endocrj.EJ12-0362","volume":"60","author":"Y Ito","year":"2013","unstructured":"Ito Y, Fukushima M, Higashiyama T, et al. Incidence and predictors of right paraesophageal lymph node metastasis of N0 papillary thyroid carcinoma located in the right lobe. Endocr J. 2013;60(3):389\u201392.","journal-title":"Endocr J"},{"key":"4012_CR21","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-914","volume":"14","author":"N Qu","year":"2014","unstructured":"Qu N, Zhang L, Ji QH, et al. Number of tumor foci predicts prognosis in papillary thyroid cancer. BMC Cancer. 2014;14:914.","journal-title":"BMC Cancer"},{"issue":"6","key":"4012_CR22","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s10585-016-9800-3","volume":"33","author":"JD Lin","year":"2016","unstructured":"Lin JD, Hsueh C, Chao TC. Soft tissue invasion of papillary thyroid carcinoma. Clin Exp Metastasis. 2016;33(6):601\u20138.","journal-title":"Clin Exp Metastasis"},{"issue":"12","key":"4012_CR23","doi-asserted-by":"publisher","first-page":"1702","DOI":"10.2967\/jnumed.121.261898","volume":"62","author":"R Seifert","year":"2021","unstructured":"Seifert R, Sch\u00e4fers MA, Heitplatz B, et al. Minimal extrathyroid extension in papillary micro carcinoma of the thyroid is an independent risk factor for relapse through lymph node and distant metastases[J]. J Nucl Med. 2021;62(12):1702\u20139.","journal-title":"J Nucl Med"},{"key":"4012_CR24","doi-asserted-by":"crossref","unstructured":"Zaydfudim V, Feurer ID, Griffin MR et al. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma[J]. Surgery, 2008, 144(6): 1070-7; discussion 1077-8.","DOI":"10.1016\/j.surg.2008.08.034"},{"issue":"6","key":"4012_CR25","doi-asserted-by":"publisher","first-page":"440","DOI":"10.1097\/RLU.0b013e31805375ca","volume":"32","author":"MR Pelizzo","year":"2007","unstructured":"Pelizzo MR, Boschin IM, Toniato A, et al. Papillary thyroid carcinoma: 35-year outcome and prognostic factors in 1858 patients. Clin Nucl Med. 2007;32(6):440\u20134.","journal-title":"Clin Nucl Med"},{"issue":"7","key":"4012_CR26","doi-asserted-by":"publisher","first-page":"1204","DOI":"10.21037\/gs-22-337","volume":"11","author":"X Xiao","year":"2022","unstructured":"Xiao X, Wu Y, Zou L, et al. Value of dissection of lymph nodes posterior to the right recurrent laryngeal nerve in patients with cN(0) papillary thyroid carcinoma. Gland Surg. 2022;11(7):1204\u201311.","journal-title":"Gland Surg"}],"container-title":["World Journal of Surgical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-025-04012-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12957-025-04012-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12957-025-04012-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,15]],"date-time":"2025-10-15T02:11:05Z","timestamp":1760494265000},"score":1,"resource":{"primary":{"URL":"https:\/\/wjso.biomedcentral.com\/articles\/10.1186\/s12957-025-04012-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,14]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["4012"],"URL":"https:\/\/doi.org\/10.1186\/s12957-025-04012-9","relation":{},"ISSN":["1477-7819"],"issn-type":[{"value":"1477-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,14]]},"assertion":[{"value":"12 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 September 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 October 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted after receiving approval from the Ethics Committee of Guangxi Medical University. The data accessed were deidentified (anonymized) and complied with the data protection and privacy regulations. No other approvals were required for data access.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}],"article-number":"374"}}