Huang Tao, Zhong Xiang, He Tianyi, Zhang Wei, He Zhixian
Department of General Surgery, Affiliated Hospital of Nantong University, Nantong, China.
Ann Transl Med. 2022 Jun;10(12):678. doi: 10.21037/atm-22-1779.
The core goal of this article is to find some meaningful risk factors that can affect the postoperative hypoparathyroidism of thyroid cancer, create an effective prediction model on this basis, and use it to selectively implement routine prophylactic calcium supplementation for patients after thyroid carcinoma surgery.
The clinicopathological characteristics of patients with papillary thyroid carcinoma (PTC) who underwent conventional bilateral total thyroidectomy (TT) + bilateral central lymph node dissection from January 2020 to August 2021 in the Affiliated Hospital of Nantong University were retrospectively analyzed. Firstly, this study analyzed the relationship between postoperative hypocalcemia and hypoparathyroidism. Then, we included many potential risk factors such as gender, age, body mass index (BMI), lateral lymph node dissection (LLND) and so on and also performed univariate and multivariate analysis of the independent risk factors for postoperative hypoparathyroidism in patients, and established a predictive scoring model.
Among the 401 patients with PTC, 50.1% developed postoperative hypoparathyroidism. There was significant difference in serum calcium concentration between normal parathyroid group and hypoparathyroidism group after thyroid carcinoma surgery. BMI <24 kg/m, lateral lymph node dissection, multifocality, and extrathyroidal extension (ETE) were all identified as independent risk factors for postoperative hypoparathyroidism. Based on these independent risk factors, a nine-point risk scoring model was created to firstly assess the postoperative parathyroid function status of patients and then to determine whether routine prophylactic calcium supplementation is needed. Importantly, the area under the curve (AUC) of the risk scoring model is equal to 0.979.
At present, prophylactic calcium supplementation after thyroid carcinoma surgery is a controversial postoperative treatment. It should be selectively implemented for high-risk patients with hypoparathyroidism after surgery. Routine prophylactic calcium supplementation is recommended for PTC patients with a score greater than or equal to 5, although there are no clinical symptoms of postoperative hypocalcemia caused by hypoparathyroidism. However, prophylactic calcium supplementation is not recommended for patients with PTC with a score of less than 5; if the patient develops hypocalcemia at the later stage, therapeutic calcium supplementation can then be implemented.
本文的核心目标是找出一些可能影响甲状腺癌术后甲状旁腺功能减退的有意义的危险因素，在此基础上创建一个有效的预测模型，并利用该模型为甲状腺癌手术后的患者选择性地实施常规预防性补钙。
回顾性分析2020年1月至2021年8月在南通大学附属医院接受常规双侧甲状腺全切除术（TT）+双侧中央淋巴结清扫术的乳头状甲状腺癌（PTC）患者的临床病理特征。首先，本研究分析了术后低钙血症与甲状旁腺功能减退之间的关系。然后，纳入了性别、年龄、体重指数（BMI）、侧方淋巴结清扫（LLND）等诸多潜在危险因素，并对患者术后甲状旁腺功能减退的独立危险因素进行单因素和多因素分析，建立了预测评分模型。
在401例PTC患者中，50.1%发生了术后甲状旁腺功能减退。甲状腺癌手术后，甲状旁腺功能正常组与甲状旁腺功能减退组的血清钙浓度存在显著差异。BMI<24kg/m²、侧方淋巴结清扫、多灶性和甲状腺外侵犯（ETE）均被确定为术后甲状旁腺功能减退的独立危险因素。基于这些独立危险因素，创建了一个九点风险评分模型，首先评估患者术后甲状旁腺功能状态，然后确定是否需要常规预防性补钙。重要的是，风险评分模型的曲线下面积（AUC）等于0.979。
目前，甲状腺癌手术后预防性补钙是一种存在争议的术后治疗方法。对于术后甲状旁腺功能减退的高危患者应选择性实施。对于评分大于或等于5分的PTC患者，尽管没有甲状旁腺功能减退引起的术后低钙血症的临床症状，也建议常规预防性补钙。然而，对于评分小于5分的PTC患者不建议预防性补钙；如果患者后期出现低钙血症，则可实施治疗性补钙。
