The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China.
Department of Surgical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Endocrinol (Lausanne). 2021 Nov 17;12:741289. doi: 10.3389/fendo.2021.741289. eCollection 2021.
Development and validation of a nomogram for the prediction of lateral lymph node metastasis (LLNM) in medullary thyroid carcinoma (MTC).
We retrospectively reviewed the clinical features of patients with MTC in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2017 and in our Department of Surgical Oncology, Hangzhou First People's Hospital between 2009 and 2019. The log-rank test was used to compare the difference in the Kaplan-Meier (K-M) curves in recurrence and survival. The nomogram was developed to predict the risk of LLNM in MTC patients. The prediction efficiency of the predictive model was assessed by area under the curve (AUC) and concordance index (C-index) and calibration curves. Decision curve analysis (DCA) was performed to determine the clinic value of the predictive model.
A total of 714 patients in the SEER database and 35 patients in our department were enrolled in our study. Patients with LLNM had worse recurrence rate and cancer-specific survival (CSS) compared with patients without LLNM. Five clinical characteristics including sex, tumor size, multifocality, extrathyroidal extension, and distant metastasis were identified to be associated with LLNM in MTC patients, which were used to develop a nomogram. Our prediction model had satisfied discrimination with a C-index of 0.825, supported by both training set and internal testing set with a C-index of 0.825, and 0.816, respectively. DCA was further made to evaluate the clinical utility of this nomogram for predicting LLNM.
Male sex, tumor size >38mm, multifocality, extrathyroidal extension, and distant metastasis in MTC patients were significant risk factors for predicting LLNM.
建立并验证用于预测甲状腺髓样癌（MTC）患者侧颈部淋巴结转移（LLNM）的列线图模型。
我们回顾性分析了 2010 年至 2017 年 SEER 数据库中 MTC 患者的临床特征，以及 2009 年至 2019 年杭州第一人民医院肿瘤外科 MTC 患者的临床特征。通过对数秩检验比较复发和生存的 Kaplan-Meier（K-M）曲线差异。建立列线图预测 MTC 患者发生 LLNM 的风险。通过曲线下面积（AUC）和一致性指数（C 指数）以及校准曲线评估预测模型的预测效率。决策曲线分析（DCA）用于确定预测模型的临床价值。
SEER 数据库中共有 714 例患者，我院有 35 例患者纳入本研究。发生 LLNM 的患者与未发生 LLNM 的患者相比，其复发率和癌症特异性生存率（CSS）更差。有 5 个临床特征，包括性别、肿瘤大小、多灶性、甲状腺外侵犯和远处转移，与 MTC 患者的 LLNM 相关，这些特征被用于开发列线图。我们的预测模型具有满意的判别能力，训练集和内部测试集的 C 指数分别为 0.825 和 0.816。进一步进行 DCA 以评估该列线图预测 LLNM 的临床实用性。
男性、肿瘤直径>38mm、多灶性、甲状腺外侵犯和远处转移是预测 MTC 患者发生 LLNM 的显著危险因素。
