Luo Yi, Xu Xiao-Cheng, Shen Jie, Shi Jing-Jing, Lu Si, He Wei, Lei Jian-Yong, Luo Ding-Cun
West China School of Medicine, Sichuan University, Chengdu, China.
Department of Surgery of Thyroid and Breast, Wujiang District of Suzhou First People's Hospital, Suzhou, China.
Cancer Manag Res. 2018 Aug 6;10:2449-2455. doi: 10.2147/CMAR.S167997. eCollection 2018.
Cervical lymph node metastasis (LNM) is a prognostic factor of papillary thyroid carcinoma (PTC). The way to deal with lymph node posterior to the right recurrent laryngeal nerve (LN-prRLN) is controversial. Nevertheless, if metastatic lymph nodes are not removed during the first operation, the subsequent salvage surgery of recurrent tumor in this area would entail high risk and complication. The purpose of this study was to develop a preoperative prediction model for LN-prRLN metastasis in PTC patients using clinicopathological characteristics.
We performed a prospective study of 595 patients with PTC who underwent LN-prRLN dissection from March 2014 to June 2017. The clinicopathological data were randomly divided into derivation (n=476) and validation sets (n=119). A predictive model was initially established based upon the data of the derivation set via multivariate analyses, and the accuracy of the model was then examined with data of the validation set. The discriminative power of this model was assessed in both sets.
Metastases of the LN-prRLN were identified in 102 (17.14%) of 595 patients. Age (odds ratio [OR] 0.971, 95% CI, 0.949-0.994, =0.013), tumor size (OR 2.163, 95% CI, 1.431-3.270, <0.001), capsular invasion (OR 1.934, 95% CI, 1.062-3.522, =0.031), and right LNM (OR 3.786, 95% CI, 2.012-7.123, <0.001) were significantly associated with LN-prRLN metastasis. The areas under the curves were 0.790 for the derivation set (sensitivity 71.95%, specificity 78.68%) and 0.878 for the validation set (sensitivity 85.00%, specificity 78.79%).
We developed and validated the first model to predict LN-prRLN metastases in patients with PTC based on clinicopathological parameters.
颈部淋巴结转移（LNM）是甲状腺乳头状癌（PTC）的一个预后因素。处理右侧喉返神经后方淋巴结（LN-prRLN）的方式存在争议。然而，如果在首次手术时未切除转移淋巴结，该区域复发性肿瘤的后续挽救性手术将带来高风险和并发症。本研究的目的是利用临床病理特征建立PTC患者LN-prRLN转移的术前预测模型。
我们对2014年3月至2017年6月期间接受LN-prRLN清扫术的595例PTC患者进行了一项前瞻性研究。临床病理数据被随机分为推导集（n = 476）和验证集（n = 119）。最初基于推导集的数据通过多变量分析建立预测模型，然后用验证集的数据检验模型的准确性。在两个集合中评估该模型的判别能力。
595例患者中有102例（17.14%）发现LN-prRLN转移。年龄（比值比[OR]0.971，95%可信区间[CI]，0.949 - 0.994，P = 0.013）、肿瘤大小（OR 2.163，95%CI，1.431 - 3.270，P < 0.001）、包膜侵犯（OR 1.934，95%CI，1.062 - 3.522，P = 0.031）和右侧LNM（OR 3.786，95%CI，2.012 - 7.123，P < 0.001）与LN-prRLN转移显著相关。推导集的曲线下面积为0.790（敏感性71.95%，特异性78.68%），验证集的曲线下面积为0.878（敏感性85.00%，特异性78.79%）。
我们基于临床病理参数开发并验证了首个预测PTC患者LN-prRLN转移的模型。
