Thompson Andrew M, Turner Robin M, Hayen Andrew, Aniss Ahmad, Jalaty Salvatore, Learoyd Diana L, Sidhu Stan, Delbridge Leigh, Yeh Michael W, Clifton-Bligh Roderick, Sywak Mark
1 Endocrine Surgical Unit, University of Sydney , Sydney, Australia .
Thyroid. 2014 Apr;24(4):675-82. doi: 10.1089/thy.2013.0224. Epub 2014 Jan 24.
Central compartment lymph node metastases in papillary thyroid carcinoma (PTC) are difficult to detect preoperatively, and the role of routine or prophylactic central compartment lymph node dissection (CLND) in managing PTC remains controversial. The aim of this project was to create a nomogram able to predict the occurrence of central compartment lymph node metastasis using readily available preoperative clinical characteristics.
Records from patients undergoing total thyroidectomy and lymph node dissection for PTC in the period 1968-2012 were analyzed. Nodal status was based on results of serial hematoxylin and eosin (H&E) examination. Age, sex, tumor size, tumor site, and multifocality were included in a multivariable logistic regression model to predict lymph node metastasis. A coefficient-based nomogram was developed and validated using an external patient cohort.
The study population included 914 patients (80% females) with an average central compartment nodal yield of eight per patient. Central compartment lymph node metastases were present in 390 patients (42.7%). The variables with the strongest predictive value were age (p<0.001), male sex (p<0.001), increasing tumor size (p<0.001), and tumor multifocality (p<0.05). The nomogram had good discrimination with a concordance index of 76.4% [95% confidence interval 73.3-79.4], supported by an external validation point estimate of 61.5% [95% confidence interval 49.5-73.6]. An online calculator and smartphone application were developed for point of care use.
A validated nomogram utilizing readily available preoperative variables has been developed to give a predicted probability of central lymph node metastases in patients presenting with PTC. This nomogram may help guide surgical decision making in PTC.
甲状腺乳头状癌（PTC）中央区淋巴结转移术前难以检测，常规或预防性中央区淋巴结清扫术（CLND）在PTC治疗中的作用仍存在争议。本项目的目的是创建一种列线图，能够利用术前易于获得的临床特征预测中央区淋巴结转移的发生。
分析1968年至2012年期间因PTC接受全甲状腺切除术和淋巴结清扫术的患者记录。淋巴结状态基于连续苏木精和伊红（H&E）检查结果。年龄、性别、肿瘤大小、肿瘤部位和多灶性纳入多变量逻辑回归模型以预测淋巴结转移。使用外部患者队列开发并验证了基于系数的列线图。
研究人群包括914例患者（80%为女性），平均每位患者中央区淋巴结检出数为8个。390例患者（42.7%）存在中央区淋巴结转移。预测价值最强的变量是年龄（p<0.001）、男性（p<0.001）、肿瘤大小增加（p<0.001）和肿瘤多灶性（p<0.05）。列线图具有良好的区分度，一致性指数为76.4%[95%置信区间73.3 - 79.4]，外部验证点估计为61.5%[95%置信区间49.5 - 73.6]支持这一结果。开发了在线计算器和智能手机应用程序以供床边使用。
已开发出一种经过验证的列线图，利用术前易于获得的变量给出PTC患者中央淋巴结转移的预测概率。该列线图可能有助于指导PTC的手术决策。
