{
  "abstract": "Background\n\nThe transportability of models for postoperative high-volume cervical nodal disease in papillary thyroid carcinoma (PTC) and the incremental predictive value of molecular variables remain uncertain.Methods\n\nWe developed models in the public Deyang cohort (521 patients; 90 events) and performed geographic external validation in the independent Liaocheng cohort (193 patients; 73 events). The outcome was >5 pathologically confirmed metastatic cervical lymph nodes. Five algorithms were compared using repeated stratified nested cross-validation with a prespecified 10-variable postoperative feature set. Ridge logistic regression (C = 0.1) was selected and applied without refitting. Paired comparisons of 8-variable clinicopathological and 10-variable clinicopathological-molecular models assessed the incremental value of high-risk co-mutation status and mutation count in both cohorts.Results\n\nInternal validation yielded an area under the receiver operating characteristic curve (AUROC) of 0.795 (95% CI, 0.745-0.842), average precision (AP) of 0.497 (0.406-0.598), and Brier score of 0.115 (0.098-0.134). External AUROC was 0.752 (0.678-0.821), AP 0.601 (0.498-0.728), and Brier score 0.217 (0.180-0.254). Observed and mean predicted risks were 37.8% and 23.9%, respectively; the observed-to-expected ratio was 1.582 (1.319-1.860) and the weak-calibration slope was 0.831 (0.542-1.191). At the prespecified threshold of 0.158, sensitivity was 0.795 and specificity 0.600. Net benefit was 0.254 for the model and 0.261 for classifying all patients as high risk (difference, -0.008; 95% CI, -0.051 to 0.033). External paired differences after adding molecular variables were +0.002 for AUROC (-0.005 to 0.010), -0.002 for AP (-0.016 to 0.010), -0.001 for Brier score (-0.002 to 0.000), and +0.009 for net benefit (-0.003 to 0.026).Conclusion\n\nThe model retained moderate discrimination across centers but underestimated absolute risk and did not demonstrate a net benefit advantage over classifying all patients as high risk at the prespecified threshold. High-risk co-mutation status and mutation count showed no clear incremental predictive value. Further validation with standardized lymph-node assessment and patient outcomes is required before clinical application.",
  "abstract_shown": true,
  "affiliations": [
    "School of Medicine, Shandong First Medical University, Jinan, China.",
    "Department of Thyroid, Breast and Hernia Surgery, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Dehao Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Jinchao Wang"
    },
    {
      "affs": [
        1
      ],
      "name": "Zhen Wu"
    },
    {
      "affs": [
        1
      ],
      "name": "Zhaoqing Cui"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9haqyf2z0096a.bib",
  "cited_by": 0,
  "doi": "10.3389/fonc.2026.1963925",
  "fulltext_url": "https://europepmc.org/articles/PMC13680251",
  "id": "9haqyf2z0096a",
  "issns": [
    "2234-943X"
  ],
  "landing_url": "https://europepmc.org/article/MED/42903142",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2712|Thyroid Cancer Diagnosis and Treatment"
    ]
  ],
  "openalex": "W7220719196",
  "pdf_url": "https://europepmc.org/articles/PMC13680251?pdf=render",
  "pmcid": "PMC13680251",
  "pmid": "42903142",
  "published": "2026-10-06",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/9haqyf2z0096a.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:57Z",
      "native_id": "MED:42903142",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42903142"
    },
    {
      "first_seen": "2026-10-30T12:20:13Z",
      "native_id": "10.3389/fonc.2026.1963925",
      "source": "crossref",
      "url": "https://www.frontiersin.org/articles/10.3389/fonc.2026.1963925/full"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2712|Thyroid Cancer Diagnosis and Treatment",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "High-volume cervical lymph node metastasis in papillary thyroid carcinoma: development and external validation of an interpretable prediction model.",
  "title_text": "High-volume cervical lymph node metastasis in papillary thyroid carcinoma: development and external validation of an interpretable prediction model.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:13Z",
  "url": "https://research.draconitic.com/paper/9haqyf2z0096a",
  "venue": "Frontiers in oncology",
  "versions": []
}