接受肺叶切除术和甲状腺切除术的具有高危特征的甲状腺乳头状癌（PTC）患者的疾病特异性生存率和无复发生存率没有显着差异。然而，尚不清楚哪种类型的单侧PTC合并同侧临床受累淋巴结（cN1）的患者可以接受较不积极的治疗。我们收集了631例诊断为单侧PTC和同侧cN1的患者的病历。这些患者最初接受了全甲状腺切除术和双侧中央淋巴结清扫术（LND），伴或不伴侧LND。我们进行了一项分析，探讨对侧隐匿性中央淋巴结转移 (CLNM) 与临床病理因素之间的关联。对侧隐匿性 CLNM 的比例为 38.9%。年龄≤45岁、肿瘤直径>1cm、肥胖和淋巴结受累区域≥2个是对侧隐匿性CLNM的独立危险因素。多灶性和同侧颈部大量淋巴结转移是术后病理因素中的独立危险因素。我们开发了一个预测模型来量化每个因素的风险，结果显示，不存在上述任何风险因素的患者，对侧隐匿性 CLNM 的概率为 20-30%，而当所有因素都存在时，该概率大于 60%基于预测列线图，我们提出了基于不同列线图分数的风险分层方案。在关于单侧 PTC 与同侧临床 LNM 的对侧中央淋巴结之间预防性中央 LND 的争论中，我们的列线图通过个人风险评估提供了平衡，以避免过度治疗和治疗不足。版权所有 © 2024 Elsevier Ltd。保留所有权利。

No significant difference in disease-specific survival and recurrence-free survival exists between papillary thyroid cancer (PTC) patients with high-risk features subjected to lobectomy and thyroidectomy. However, it is unclear which type of patients with unilateral PTC combined with ipsilateral clinical involved lymph nodes (cN1) can receive a less aggressive treatment.We collected the medical records of 631 patients diagnosed with unilateral PTC and ipsilateral cN1. These patients initially underwent total thyroidectomy and bilateral central lymph node dissection (LND), with or without lateral LND. We conducted an analysis to investigate the associations between contralateral occult central lymph node metastasis (CLNM) and clinicopathologic factors.The proportion of contralateral occult CLNM was 38.9 %. Age ≤45 years, tumor diameter >1 cm, obesity, and involvement of lymph node regions ≥2 were independent risk factors for contralateral occult CLNM. Multifocality and ipsilateral neck high-volume lymph node metastases were independent risk factors among the postoperative pathological factors. A predicting model was developed to quantify the risk of each factor, which revealed that patients without any of the risk factors mentioned above had a 20-30 % probability of contralateral occult CLNM, whereas the probability was greater than 60 % when all factors were present.Based on the predictive nomograms, we proposed a risk stratification scheme based on different nomogram scores. In the debate about prophylactic central LND among contralateral central lymph node in unilateral PTC with ipsilateral clinical LNM, our nomograms provide the balance to avoid overtreatment and undertreatment through personal risk assessment.Copyright © 2024 Elsevier Ltd. All rights reserved.