Lei Jianyong, Li Gengpeng, Li Zhihui, Rong R X, Zhu Jingqiang
Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu 610041, China.
Oncotarget. 2017 Nov 30;9(1):167-177. doi: 10.18632/oncotarget.22772. eCollection 2018 Jan 2.
Our present study aimed to evaluate and compare the number and rate of central lymph node metastases (LNMs) for the prediction of lateral LNM (LLNM) in papillary thyroid carcinoma (PTC) and to develop a scoring system.
Capsule invasion, tumor location in the upper portion of the thyroid, an ipsilateral central compartment LNM number ≥3, and an ipsilateral central compartment LNM rate of ≥56% were identified as significant independent predictors of ipsilateral lateral LNM in PTC. The predictive ability of an ipsilateral central compartment LNM rate ≥56% (area under the curve (AUC) = 0.802) was better than that of an ipsilateral central compartment LNM number ≥3 (AUC = 0.755). The ROC curves identified the best index point (CUNR) to distinguish the presence or absence of ipsilateral LLNM as 11, which has a high sensitivity (0.860) and a low false-negative rate (0.100, 1-Specificity). These findings were supported by the validation cohort.
Patients with a CUNR index point equal to or greater than 11 and ipsilateral lateral lymph node dissection should be considered for a diagnosis of LLNM.
A total of 1,281 PTC patients were included and divided into two groups: those with a presence of LLNM ( = 222) and those with an absence of LLNM ( = 1059). Univariate and multivariate analyses were performed to detect the risk factors for LLNM, and receiver operating characteristic (ROC) curves were used to detect the best cutoff values of these predictors. Additionally, a scoring system for the odds ratio (OR) of independent factors was developed and validated in an independent cohort of PTC patients ( = 560).
本研究旨在评估和比较甲状腺乳头状癌（PTC）中央区淋巴结转移（LNM）的数量和发生率，以预测侧方淋巴结转移（LLNM），并建立一个评分系统。
被膜侵犯、肿瘤位于甲状腺上部、同侧中央区LNM数量≥3以及同侧中央区LNM发生率≥56%被确定为PTC同侧LLNM的重要独立预测因素。同侧中央区LNM发生率≥56%（曲线下面积（AUC）=0.802）的预测能力优于同侧中央区LNM数量≥3（AUC = 0.755）。ROC曲线确定区分同侧LLNM有无的最佳指标点（CUNR）为11，其具有高敏感性（0.860）和低假阴性率（0.100，1-特异性）。这些发现得到了验证队列的支持。
CUNR指标点等于或大于11且进行同侧侧方淋巴结清扫的患者应考虑诊断为LLNM。
共纳入1281例PTC患者，分为两组：有LLNM的患者（=222例）和无LLNM的患者（=1059例）。进行单因素和多因素分析以检测LLNM的危险因素，并使用受试者工作特征（ROC）曲线检测这些预测因素的最佳截断值。此外，还开发了一个独立因素比值比（OR）的评分系统，并在一个独立的PTC患者队列（=560例）中进行了验证。
