摘要
目的探讨术前淋巴结阴性(clinical lymph negative,cN0)甲状腺微小乳头状癌(paillary thyroid microcarcinoma,PTMC)中央区淋巴结转移(central lymph node metastasis,CLNM)的危险因素,并建立预测cN0 PTMC CLNM概率的列线图模型。方法回顾性分析兰州大学第二医院普外科2016年8月至2020年8月收治的192例cN0 PTMC患者临床病理资料。男41例,女151例,50例存在CLNM,142例无CLNM。依据是否病理证实存在CLNM将患者分为2组,转移组及未转移组。统计分析患者年龄、性别、瘤体直径、多灶性、是否伴桥本氏病、是否合并结节性甲状腺肿(结甲)、是否近后背膜、纵横比是否>1、是否存在瘤外浸润、是否存在淋巴结肿大、促甲状腺激素(thyroid stimulating hormone,TSH)水平、甲状腺球蛋白(thyroglobulin,TG)水平,用Pearson卡方检验对假设检验的计数资料进行分析,使用R语言软件包进行Logistic多因素分析,通过逐步回归的方法筛选入组条件从而建立列线图预测模型,并应用Bootstrap法进行模型验证。P<0.05为差异具有统计学意义。结果多因素Logistic分析显示瘤外浸润(P=0.032)、存在淋巴结肿大(P=0.010)、TG>68μg/L(P=0.007)为CLNM的危险因素。逐步回归建立最优模型入组因素包括瘤体直径≥0.5 cm、合并结节性甲状腺肿、瘤外浸润、存在淋巴结肿大、TG>68μg/L(AIC:212.27),根据上述危险因素建立列线图模型,一致性指数(Harrell’concordance index,c-index)为0.711。校准图绘制结果及内外部验证,结果证明其一致性及适用性良好。结论瘤外浸润、淋巴结肿大、TG>68μg/L是cN0 PTMC CLNM的危险因素,研究中建立的列线图可有效对cN0 PTMC患者CLNM率进行预测,有助于临床医生的诊疗决策。
Objective To investigate the risk factors of central lymph node metastasis(CLNM)in cN0 paillary thyroicl microcarcinoma(PTMC)and to establish a nomogram model for predicting the probability of cN0 PTMC CLNM.Methods The clinicopathological data of 192 patients with cN0 PTMC admitted to the Department of General Surgery of the Second Hospital of Lanzhou University from Aug.2016 to Aug.2020 were retrospectively analyzed.There were 41 males and 151 females,50 with CLNM and 142 without CLNM.The patients were divided into 2 groups according to the presence or absence of pathologically confirmed CLNM.Patient’s age,gender,tumor diameter,multiple,with Hashimoto’s disease,with nodular goiter,with or without near the posterior dorsal membrane,aspect ratio>1,with or without extratumoral infiltration,with or without lymphadenopathy,TSH levels,and TG levels were statistically analyzed.Pearson chi-square test was used to analyze the count data of hypothesis test,and the R language software package was used for Logistic multivariate analysis.The entry conditions were screened by stepwise regression to establish a nomogram prediction model,and the Bootstrap method was used for model verification.P<0.05 was considered statistically significant.Results Multivariate logistic analysis showed that extratumoral invasion(P=0.032),presence of lymphadenopathy(P=0.010),and TG>68μg/L(P=0.007)were risk factors for central lymph node metastasis.The optimal model was established by stepwise regression.The factors included tumor diameter≥0.5 cm,nodular goiter,extratumoral invasion,lymphadenopathy and TG>68μg/L(AIC:212.27).The nomogram model was established according to the above risk factors.The consistency index(c-index)was 0.711.The results of calibration graph drawing and internal and external validation demonstrated its good consistency and applicability.Conclusion Extratumoral invasion,lymphadenopathy,and TG>68μg/L are risk factors for cN0 PTMC CLNM,and the nomogram established in the study can effectively predict the CLNM rate in patients with cN0PTMC and contribute to clinicians’diagnosis and treatment decisions.
作者
马铭玉
崔乐
邹丹
柴雅晖
宋爱琳
Ma Mingyu;Cui Le;Zou Dan;Chai Yahui;Song Ailin(Department of General Surgery,Lanzhou University Second Hospital,Lanzhou 730030,China)
出处
《中华内分泌外科杂志》
CAS
2021年第2期154-157,共4页
Chinese Journal of Endocrine Surgery
基金
甘肃省自然科学基金(20JR5RA342)。
关键词
甲状腺微小乳头状癌
中央区淋巴结转移
结节性甲状腺肿
瘤外浸润
风险评估
Papillary thyroid microcarcinoma
Central lymph node matastasis
Nodular goiter
Extratumoral infiltration
Risk Assessment
