Integrating multi-omics and machine learning to unravel mechanisms of lymph node metastasis in papillary carcinoma with and without thyroiditis

PTC-blank and PTC-thyroiditis exhibit distinct LNM mechanisms: ECM remodeling and fibroblast infiltration are associated with metastasis in PTC-blank, while immune dysregulation appears to be more prominent in PTC-thyroiditis. The identified 17-gene model offers robust predictive value for LNM risk, and SHISA5 represents a novel causal gene and potential therapeutic target. These findings provide insights into subtype-specific management strategies for PTC patients.