Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, China.
Langenbecks Arch Surg. 2023 Aug 16;408(1):315. doi: 10.1007/s00423-023-03033-w.
The prognostic significance of lymph node ratio (LNR) in N1b papillary thyroid cancer is unclear. Therefore, the impact of LNR on disease-specific mortality (DSM) and overall survival (OS) in patients with N1b papillary thyroid cancer (PTC) needs to be defined.
We used the Surveillance, Epidemiology, and End Results (SEER) database of patients who had undergone thyroidectomy and lymph node dissection. Factors associated with DSM and OS were analyzed and identified using univariate and multivariate Cox proportional risk models. X-tile software was used to find the best cutoff value of LNR. Kaplan-Meier estimates for DSM were plotted for LNR and were compared with the log-rank test. The ROC curve evaluated the validity of the model.
A total of 3223 patients with N1b PTC were identified in the SEER database between 1975 and 2019. The best cutoff value for LNR was 0.6. The multivariate Cox proportional risk model showed that age, race, T3/T4 classification, distant metastasis, extent of surgery, number of metastatic lymph nodes, and LNR > 0.6 were independent risk factors for DSM (all p < 0.05). Age, sex, T4 classification, distant metastasis, extent of surgery, and LNR > 0.6 were independent risk factors for OS (all p < 0.05). The Kaplan-Meier method plotted a cumulative risk curve and showed that patients with LNR > 0.6 had a significantly higher risk of DSM than patients with LNR ≤ 0.6 (p = 0.002).
LNR was a powerful predictor of DSM and OS in N1b PTC patients. LNR could be a useful tool for the stratification of PTC patients with lateral neck metastases.
淋巴结比值（LNR）在 N1b 型甲状腺乳头状癌中的预后意义尚不清楚。因此，需要确定 LNR 对 N1b 型甲状腺乳头状癌（PTC）患者疾病特异性死亡率（DSM）和总生存率（OS）的影响。
我们使用了接受甲状腺切除术和淋巴结清扫术的患者的监测、流行病学和最终结果（SEER）数据库。使用单变量和多变量 Cox 比例风险模型分析并确定与 DSM 和 OS 相关的因素。X-tile 软件用于找到 LNR 的最佳截断值。绘制 LNR 的 DSM 的 Kaplan-Meier 估计值，并与对数秩检验进行比较。ROC 曲线评估模型的有效性。
在 1975 年至 2019 年期间，SEER 数据库中确定了 3223 例 N1b PTC 患者。LNR 的最佳截断值为 0.6。多变量 Cox 比例风险模型显示，年龄、种族、T3/T4 分类、远处转移、手术范围、转移淋巴结数量和 LNR>0.6 是 DSM 的独立危险因素（均 p<0.05）。年龄、性别、T4 分类、远处转移、手术范围和 LNR>0.6 是 OS 的独立危险因素（均 p<0.05）。Kaplan-Meier 方法绘制了累积风险曲线，表明 LNR>0.6 的患者 DSM 的风险明显高于 LNR≤0.6 的患者（p=0.002）。
LNR 是 N1b PTC 患者 DSM 和 OS 的有力预测指标。LNR 可能是用于分层有侧颈部转移的 PTC 患者的有用工具。
