Zhang Lina, Ling Yuwei, Zhao Ye, Li Kaifu, Zhao Jing, Kang Hua
Department of General Surgery, Center for Thyroid and Breast Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
Department of Colorectal Surgery, PLA Rocket Force Characteristics Medical Center, Beijing, China.
Front Surg. 2021 Dec 3;8:742328. doi: 10.3389/fsurg.2021.742328. eCollection 2021.
The aim of this study was to establish a practical nomogram for preoperatively predicting the possibility of cervical lymph node metastasis (CLNM) based on clinicopathological and ultrasound (US) imaging characteristics in patients with clinically node-negative (cN0) unilateral papillary thyroid microcarcinoma (PTMC) in order to determine a personal surgical volume and therapeutic strategy. A total of 269 consecutive patients diagnosed with cN0 unilateral PTMC by postoperative pathological examination from January 2018 to December 2020 were retrospectively analyzed. All the patients underwent lobectomy or thyroidectomy with routine prophylactic central lymph node dissection (CLND) and were divided into a CLNM group and a non-CLNM group. Using logistic regression, the least absolute shrinkage and selection operator (LASSO) regression analysis was applied to determine the risk factors for CLNM in patients with unilateral cN0 PTMC. A nomogram including risk-factor screening using LASSO regression for predicting the CLNM in patients with cN0 unilateral PTMC was further developed and validated. Risk factors identified by LASSO regression, including age, sex, tumor size, presence of extrathyroidal extension (ETE), tumor diameter/lobe thickness (D/T), tumor location, and coexistent benign lesions, were potential predictors for CLNM in patients with cN0 unilateral PTMC. Meanwhile, age (odds ratio [OR] = 0.261, 95% CI.104-0.605; = 0.003), sex (men: OR = 3.866; 95% CI 1.758-8.880; < 0.001), ETE (OR = 3.821; 95% CI 1.168-13.861; = 0.032), D/T (OR = 72.411; 95% CI 5.483-1212.497; < 0.001), and coexistent benign lesions (OR = 3.112 95% CI 1.407-7.303; = 0.007) were shown to be significantly related to CLNM by multivariant logistic regression. A nomogram for predicting CLNM in patients with cN0 unilateral PTMC was established based on the risk factors identified by the LASSO regression analysis. The receiver operating characteristic (ROC) curve for predicting CLNM by nomogram showed that the area under the curve (AUC) was 0.777 and exhibited an excellent consistency. A nomogram based on clinical and US imaging characteristics for predicting the probability of CLNM in patients with cN0 unilateral PTMC was developed, which showed a favorable predictive value and consistency. Further prospective research to observe the oncological outcomes is necessary to determine whether the nomogram could potentially guide a personalized surgical volume and surgical approach.
本研究旨在基于临床病理和超声（US）影像特征，为临床淋巴结阴性（cN0）的单侧甲状腺微小乳头状癌（PTMC）患者建立一个术前预测颈部淋巴结转移（CLNM）可能性的实用列线图，以确定个体化的手术范围和治疗策略。回顾性分析了2018年1月至2020年12月期间经术后病理检查确诊为cN0单侧PTMC的269例连续患者。所有患者均接受了叶切除术或甲状腺切除术及常规预防性中央淋巴结清扫（CLND），并分为CLNM组和非CLNM组。采用逻辑回归分析，应用最小绝对收缩和选择算子（LASSO）回归分析确定单侧cN0 PTMC患者CLNM的危险因素。进一步开发并验证了一个包括使用LASSO回归进行危险因素筛选以预测cN0单侧PTMC患者CLNM的列线图。LASSO回归确定的危险因素，包括年龄、性别、肿瘤大小、甲状腺外侵犯（ETE）的存在、肿瘤直径/叶厚度（D/T）、肿瘤位置和并存的良性病变，是cN0单侧PTMC患者CLNM的潜在预测因素。同时，多变量逻辑回归显示，年龄（比值比[OR]=0.261，95%可信区间0.104 - 0.605；P = 0.003）、性别（男性：OR = 3.866；95%可信区间1.758 - 8.880；P < 0.001）、ETE（OR = 3.821；95%可信区间1.168 - 13.861；P = 0.032）、D/T（OR = 72.411；95%可信区间5.483 - 1212.497；P < 0.001）和并存的良性病变（OR = 3.112，95%可信区间1.407 - 7.303；P = 0.007）与CLNM显著相关。基于LASSO回归分析确定的危险因素，建立了cN0单侧PTMC患者CLNM的预测列线图。通过列线图预测CLNM的受试者工作特征（ROC）曲线显示，曲线下面积（AUC）为0.777，具有良好的一致性。开发了基于临床和US影像特征预测cN0单侧PTMC患者CLNM概率的列线图，其显示出良好的预测价值和一致性。有必要进行进一步的前瞻性研究以观察肿瘤学结局，以确定该列线图是否有可能指导个体化的手术范围和手术方式。
