Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China.
Department of Thyroid and Breast Surgery, Binzhou Medical University Hospital, Binzhou, Shandong, China.
PeerJ. 2023 Mar 13;11:e15025. doi: 10.7717/peerj.15025. eCollection 2023.
The purpose of this study is to evaluate the relationship between lymph node status (the number of resected lymph nodes; the number of metastatic lymph nodes, LNM, and lymph node ratio, LNR) and biochemical recurrence, disease-free survival (DFS), as well as overall survival (OS) in medullary thyroid carcinoma (MTC).
This study enrolled MTC patients at Tianjin Medical University Cancer Institute and Hospital between 2011 and 2019. We used Logistic regression analysis, Cox regression models and Kaplan-Meier test to identify risk factors influencing biochemical recurrence, DFS, and OS.
We identified 160 patients who satisfied the inclusion criteria from 2011 to 2019. We used ROC analysis to define the cut-off value of LNR with 0.24. Multifocality, preoperative calcitonin levels, pathologic N stage, resected lymph nodes, LNM, LNR, and the American Joint Committee on Cancer (AJCC) clinical stage were significant ( < 0.05) prognostic factors influencing biochemical cure. In univariable analyses, gross extrathyroidal extension, preoperative calcitonin levels, pathologic T classification, pathologic N stage, resected lymph nodes, LNM, LNR, AJCC clinical stage, and biochemical cure were significant ( < 0.05) factors of DFS. When the multivariable analysis was performed, LNR was identified as predictor of DFS (HR = 4.818, 95% CI [1.270-18.276]). Univariable Cox regression models reflected that tumor size, pathologic N stage, and LNR were predictor of OS. Furthermore, multivariable analysis manifested that LNR was predictor of OS (HR = 10.061, 95% CI [1.222-82.841]).
This study illustrated that LNR was independent prognostic factor of DFS and OS in MTC. In addition, LNR influenced biochemical cure. Further investigations are needed to determine the optimal cut-off value for predicting prognosis.
本研究旨在评估颈淋巴结状态（切除的淋巴结数量；转移淋巴结数量、淋巴结转移率和淋巴结比率）与髓样甲状腺癌（MTC）患者生化复发、无病生存（DFS）和总生存（OS）之间的关系。
本研究纳入了 2011 年至 2019 年在天津医科大学肿瘤医院就诊的 MTC 患者。我们使用 Logistic 回归分析、Cox 回归模型和 Kaplan-Meier 检验来确定影响生化复发、DFS 和 OS 的危险因素。
我们从 2011 年至 2019 年共纳入 160 名符合纳入标准的患者。我们使用 ROC 分析确定 LNR 的截断值为 0.24。多灶性、术前降钙素水平、病理 N 分期、切除的淋巴结、LNM、LNR 和美国癌症联合委员会（AJCC）临床分期是影响生化治愈的显著（<0.05）预后因素。在单变量分析中，大体甲状腺外侵犯、术前降钙素水平、病理 T 分类、病理 N 分期、切除的淋巴结、LNM、LNR、AJCC 临床分期和生化治愈是 DFS 的显著（<0.05）因素。当进行多变量分析时，LNR 是 DFS 的预测因素（HR=4.818，95%CI[1.270-18.276]）。单变量 Cox 回归模型反映肿瘤大小、病理 N 分期和 LNR 是 OS 的预测因素。此外，多变量分析表明 LNR 是 OS 的预测因素（HR=10.061，95%CI[1.222-82.841]）。
本研究表明 LNR 是 MTC 患者 DFS 和 OS 的独立预后因素。此外，LNR 影响生化治愈。需要进一步的研究来确定预测预后的最佳截断值。
