An Yanhua, Lu Jingkai, Hu Mosheng, Cao Qiumei
Department of General Practice, Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, China.
Department of Emergency Medicine, The 305th Hospital of PLA, Beijing, China.
Front Surg. 2023 Jan 13;9:1044971. doi: 10.3389/fsurg.2022.1044971. eCollection 2022.
To explore the predictive value of lymph node ratio (LNR) for the prognosis of medullary thyroid carcinoma (MTC) patients, and constructed prediction models for the 5-year, 10-year and 20-year mortality of MTC patients based on LNR and other predictors.
This cohort study extracted the data of 2,093 MTC patients aged ≥18 years undergoing total thyroidectomy and neck lymph nodes dissection. Kaplan-Meier curves and log-rank tests were performed to compare survival curves between LNR < 15% group and LNR ≥ 15% group. All data was divided into the training set ( = 1,465) and the testing set ( = 628). The random survival forest model was constructed in the training set and validated in the testing set. The area under the curve (AUC) was employed for evaluating the predictive ability of the model.
The 5-year, 10-year and 20-year overall survival (OS) and cause-specific survival (CSS) of MTC patients with LNR <15% were higher than those with LNR ≥15%. The OS was 46% and the CSS was 75% after 20 years' follow-up. The AUC of the model for the 5-year, 10-year, and 20-year OS in MTC patients was 0.878 (95%CI: 0.856-0.900), 0.859 (95%CI: 0.838-0.879) and 0.843 (95%CI: 0.823-0.862) in the training set and 0.845 (95%CI: 0.807-0.883), 0.841 (95%CI: 0.807-0.875) and 0.841 (95%CI: 0.811-0.872) in the testing set. In the training set, the AUCs were 0.869 (95%CI: 0.845-0.892), 0.843 (95%CI: 0.821-0.865), 0.819 (95%CI: 0.798-0.840) for the 5-year, 10-year and 20-year CCS in MTC patients, respectively. In the testing set, the AUCs were 0.857 (95%CI: 0.822-0.892), 0.839 (95%CI: 0.805-0.873) and 0.826 (95%CI: 0.794-0.857) for the 5-year CCS, 10-year CCS and 20-year CCS in MTC patients, respectively.
The models displayed good predictive performance, which might help identify MTC patients might have poor outcomes and appropriate interventions should be applied in these patients.
探讨淋巴结比率（LNR）对甲状腺髓样癌（MTC）患者预后的预测价值，并基于LNR及其他预测因素构建MTC患者5年、10年和20年死亡率的预测模型。
本队列研究提取了2093例年龄≥18岁接受全甲状腺切除术和颈部淋巴结清扫术的MTC患者的数据。采用Kaplan-Meier曲线和对数秩检验比较LNR＜15%组和LNR≥15%组的生存曲线。所有数据分为训练集（n = 1465）和测试集（n = 628）。在训练集中构建随机生存森林模型，并在测试集中进行验证。采用曲线下面积（AUC）评估模型的预测能力。
LNR＜15%的MTC患者的5年、10年和20年总生存（OS）率及病因特异性生存（CSS）率均高于LNR≥15%的患者。随访20年后，OS率为46%，CSS率为75%。在训练集中，MTC患者5年、10年和20年OS的模型AUC分别为0.878（95%CI：0.856 - 0.900）、0.859（95%CI：0.838 - 0.879）和0.843（95%CI：0.823 - 0.862），在测试集中分别为0.845（95%CI：0.807 - 0.883）、0.841（95%CI：0.807 - 0.875）和0.841（95%CI：0.811 - 0.872）。在训练集中，MTC患者5年、10年和20年CSS的AUC分别为0.869（95%CI：0.845 - 0.892）、0.843（95%CI：0.821 - 0.865）、0.819（95%CI：0.798 - 0.840）。在测试集中，MTC患者5年、10年和20年CSS的AUC分别为0.857（95%CI：0.822 - 0.892）、0.839（95%CI：0.805 - 0.873）和0.826（95%CI：0.794 - 0.857）。
模型显示出良好的预测性能，这可能有助于识别预后可能较差的MTC患者，并应对这些患者采取适当的干预措施。
