1 Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University , Chengdu, China .
2 Department of Pathology, West China Hospital of Sichuan University , Chengdu, China .
Thyroid. 2018 Mar;28(3):301-310. doi: 10.1089/thy.2017.0422.
The extent of metastatic lymph node (LN) invasion was not considered in the postoperative stratification of the recurrence risk of papillary thyroid carcinoma (PTC) in the 2015 American Thyroid Association (ATA) guidelines, and the recommended risk stratification cannot be applied to individuals. A nomogram based on these risk factors was developed based on the risk factors to predict individual recurrence risk.
Data from 1788 PTC patients at the West China Hospital and 306 cases from the Shang Jin Nan Fu Hospital between August 2013 and July 2015 were included in this study. The 1788 cases were randomized into two groups-the training set (896 cases) and the testing set (896 cases)-and 306 cases were used as the external evaluation set.
Univariate and multivariate analyses identified the following independent prognostic factors associated with recurrence in the three independent sets and the combined set (p < 0.01): LN invasion in the capsule or organ, more than five metastatic LNs, and a largest metastatic LN diameter >3 cm. Importantly, PTC patients showed significantly different recurrence rates depending on the extent of LN invasion in the three sets and in the combined set (p < 0.001). The nomogram was developed based on the risk factors in the training set and was validated in the independent testing and validation sets.
The largest LN metastasis diameter, number of metastatic LNs, and the extent of extranodal invasion had significant prognostic value for predicting the risk of recurrence. Based on the characteristics of the thyroidal PTC lesion and metastatic LNs, the nomogram showed good prediction of recurrence in individual PTC patients.
2015 年美国甲状腺协会（ATA）指南中并未考虑甲状腺乳头状癌（PTC）患者淋巴结转移（LN）侵犯程度在术后复发风险分层中的作用，且推荐的风险分层无法应用于个体。本研究基于这些危险因素，开发了一种列线图，用于预测个体的复发风险。
本研究纳入了 2013 年 8 月至 2015 年 7 月期间华西医院的 1788 例 PTC 患者和上海瑞金医院的 306 例患者的数据。1788 例患者被随机分为两组——训练集（896 例）和测试集（896 例），并使用 306 例作为外部验证集。
单因素和多因素分析确定了以下与三个独立数据集和合并数据集（p < 0.01）中复发相关的独立预后因素：LN 侵犯包膜或器官、转移的 LN 超过 5 个、最大转移 LN 直径 >3 cm。重要的是，PTC 患者在三个数据集和合并集中的复发率差异有统计学意义（p < 0.001）。该列线图是基于训练集中的危险因素开发的，并在独立的测试和验证集中进行了验证。
最大 LN 转移直径、转移 LN 数量和 LN 外侵犯程度对预测复发风险具有显著的预后价值。基于甲状腺 PTC 病变和转移 LN 的特征，该列线图对个体 PTC 患者的复发具有良好的预测能力。
