Clinicopathological predictors of right para esophageal lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis

doi:10.5306/wjco.v16.i11.110792

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World Journal of Clinical Oncology

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Meta-Analysis

World J Clin Oncol. Nov 24, 2025; 16(11): 110792
Published online Nov 24, 2025. doi: 10.5306/wjco.v16.i11.110792

Clinicopathological predictors of right para esophageal lymph node metastasis in papillary thyroid carcinoma: A systematic review and meta-analysis

Mirza Muhammad Hadeed Khawar, Muhammad Hanan Abid, Muhammad Bilal A Cheema, Muneeb Khawar, Muneeba Shaukat, Muhammad Huzaifa A Khan, Muneeb Saifullah, Rimsha Noureen, Hamza Aka Khail, Ali Akram Qureshi, Muhammad Abbas Khokhar

Mirza Muhammad Hadeed Khawar, Department of Medicine, Services Institute of Medical Sciences, Lahore 54000, Punjab, Pakistan

Muhammad Hanan Abid, Muhammad Bilal A Cheema, Muneeb Khawar, Muneeba Shaukat, Muhammad Huzaifa A Khan, Muneeb Saifullah, Rimsha Noureen, Ali Akram Qureshi, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan

Hamza Aka Khail, Department of Medicine, Kateb University Faculty of Medicine, Kabul 1006, Afghanistan

Muhammad Abbas Khokhar, Department of Oncology and Radiotherapy, King Edward Medical University, Lahore 54000, Punjab, Pakistan

Author contributions: Khawar MMH contributed to conceptualization; Khawar MMH, Abid MH, Shaukat M, Khan MHA, Saifullah M, Khail HA, Qureshi AA, and Khokhar MA contributed to data curation; Khawar MMH, Cheema MBA, and Khawar M contributed to writing-original draft; Khawar MMH, Khan MHA, Qureshi AA, and Khokhar MA contributed to methodology; Abid MH, Cheema MBA, Khawar M, and Noureen R contributed to formal analysis. All authors have conducted the final review and editing of the manuscript.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

Corresponding author: Hamza Aka Khail, MD, Department of Medicine, Kateb University Faculty of Medicine, Shaheed Mazari Road, Kabul 1006, Afghanistan. hamzaakakhail14@gmail.com

Received: June 16, 2025
Revised: June 27, 2025
Accepted: October 13, 2025
Published online: November 24, 2025
Processing time: 159 Days and 10.3 Hours

Abstract

BACKGROUND

Dissection of the right paraesophageal lymph node (RPELN) in managing papillary thyroid carcinoma remains a contentious issue. This meta-analysis assesses previously established and novel risk factors associated with RPELN metastasis.

AIM

To evaluate previously established and novel risk factors associated with RPELN metastasis in patients with papillary thyroid carcinoma papillary thyroid carcinoma through a comprehensive meta-analysis.

METHODS

We searched MEDLINE (via PubMed), ScienceDirect, Scopus and EMBASE up to December 2024. Studies were assessed using the Newcastle-Ottawa Scale. Statistical analysis was conducted with RevMan version 5.4, using the Q-test and I²-test for heterogeneity. Sensitivity was evaluated with the leave-one-out method, and publication bias with the Egger regression test and funnel plot.

RESULTS

Of 2444 articles retrieved, 26 were included in our meta-analysis with 16427 patients. The RPELN metastasis rate was 12.98% [95% confidence interval (CI): 12.46%-13.50%]. The pooled results suggested that age < 55 years [odds ratio (OR) = 1.71, 95%CI: 1.35-2.16, P < 0.00001], sex (OR = 0.60, 95%CI: 0.54-0.67, P < 0.00001), tumor size 1 cm (OR = 3.37, 95%CI: 2.69-4.21, P < 0.00001), multifocality (OR = 1.81, 95%CI: 1.49-2.20, P < 0.00001), capsular invasion (OR = 2.94, 95%CI: 2.05-4.20, P < 0.00001), vascular invasion (OR = 2.16, 95%CI: 1.56-2.99, P < 0.00001), extra-thyroid extension (OR = 3.30, 95%CI: 1.82-5.98, P < 0.0001), central lymph node metastasis (OR = 7.77, 95%CI: 4.73-12.76, P < 0.00001), lateral lymph node metastasis (OR = 6.94, 95%CI: 6.11-7.89, P < 0.00001), Hashimoto thyroiditis (OR = 0.79, 95%CI: 0.69-0.92, P = 0.002), micro-calcifications (OR = 2.29, 95%CI: 1.20-4.37, P = 0.01), and echogenicity (OR = 0.62, 95%CI: 0.40-0.98, P = 0.04) should be considered with RPELN metastasis.

CONCLUSION

The male < 55, tumor size > 1 cm, multifocality, capsular and vascular invasion, extrathyroidal extension, lymph node metastasis, and Hashimoto thyroiditis were significantly associated with RPELN metastasis and should be carefully assessed during dissection.

Keywords: Papillary thyroid carcinoma; Right paraesophageal lymph node; Risk factors; Predictors; Metastasis

Core Tip: Several factors significantly associated with right paraesophageal lymph node metastasis include age under 55 years, sex, tumor size of 1 cm, multifocality, capsular invasion, vascular invasion, extra-thyroid extension, central and lateral lymph node metastasis, Hashimoto thyroiditis, microcalcifications, and echogenicity. In contrast, tumor location and margins were not significantly associated. These findings highlight the need for thorough evaluation and proactive surgical intervention in patients with papillary thyroid carcinoma papillary thyroid carcinoma who exhibit these risk factors to manage potential right paraesophageal lymph node involvement.