Liu Shiyang, Liu Chenguang, Zhao Lu, Wang Kun, Li Shuyu, Tian Yao, Jiao Bo, Gui Zhengwei, Yu Tianyao, Zhang Lin
Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China.
Department of Anesthesiology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, Hubei Province, 430030, China.
Eur J Surg Oncol. 2021 Nov;47(11):2774-2780. doi: 10.1016/j.ejso.2021.08.033. Epub 2021 Aug 27.
Cervical lateral lymph node metastasis (LLNM) is a predictor of poor prognosis for papillary thyroid carcinoma (PTC) patients. However, the risk factors for LLNM remain unclear. The purpose of the study was to examine the risk factors for LLNM and construct a prediction model.
With Ethics Committee approval, a total of 1198 PTC patients were retrospectively included in our study. Univariate and multivariate analyses were performed to explore the relationship between clinicopathological characteristics and LLNM. A nomogram for predicting LLNM in PTC patients with central lymph node metastasis (CLNM) was constructed and validated.
The negative BRAF protein expression was significantly correlated with positive LLNM status in PTC patients. In PTC patients with CLNM, the number of metastatic central lymph nodes (LNN) ≥ 3 and the ratio of metastatic central lymph nodes (LNR) ≥ 0.565 were found to be significantly associated with positive LLNM status. The nomogram for predicting LLNM risk in PTC patients with CLNM incorporated four risk factors: tumor size, the BRAF protein expression, LNN and LNR. The prediction model showed excellent discrimination, with a C-index of 0.714.
The negative BRAF protein expression was more likely to lead to LLNM. LNN ≥3 and LNR ≥0.565 were associated with LLNM risk in PTC patients with CLNM. Our nomogram might assist clinicians in developing individual suitable follow-up strategies for PTC patients with CLNM.
颈部侧方淋巴结转移（LLNM）是乳头状甲状腺癌（PTC）患者预后不良的一个预测指标。然而，LLNM的危险因素仍不清楚。本研究的目的是探讨LLNM的危险因素并构建一个预测模型。
经伦理委员会批准，本研究回顾性纳入了1198例PTC患者。进行单因素和多因素分析以探讨临床病理特征与LLNM之间的关系。构建并验证了用于预测有中央淋巴结转移（CLNM）的PTC患者发生LLNM的列线图。
PTC患者中BRAF蛋白表达阴性与LLNM阳性状态显著相关。在有CLNM的PTC患者中，发现转移的中央淋巴结数量（LNN）≥3个以及转移的中央淋巴结比例（LNR）≥0.565与LLNM阳性状态显著相关。用于预测有CLNM的PTC患者发生LLNM风险的列线图纳入了四个危险因素：肿瘤大小、BRAF蛋白表达、LNN和LNR。该预测模型显示出良好的区分度，C指数为0.714。
BRAF蛋白表达阴性更有可能导致LLNM。LNN≥3个和LNR≥0.565与有CLNM的PTC患者发生LLNM的风险相关。我们的列线图可能有助于临床医生为有CLNM的PTC患者制定个性化的合适随访策略。
