Zhao Yingyan, Li Weiwei, Tao Lingling, Fan Jinfang, Zhan Weiwei, Zhou Wei
Department of Ultrasound, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Ultrasound, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Gland Surg. 2024 Feb 29;13(2):178-188. doi: 10.21037/gs-23-376. Epub 2024 Feb 23.
Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy. Skip metastases of PTCs are easily misdiagnosed before surgery, and it could lead to re-operation and affect the prognosis. Although there are a few studies about nomograms for predicting central lymph node metastases (CLNM) or lateral lymph node metastases (LLNM) of PTCs, there are few studies about nomograms for skip metastases. Based on the clinical and ultrasonographic characteristics of patients with PTCs, the aim of our study was to investigate the risk factors and establish a nomogram for predicting the risk of skip metastases in PTCs.
This study enrolled 218 PTCs patients with lateral cervical lymph node metastases and their data were analyzed retrospectively. According to the postoperative pathological results, the patients were divided into skip-positive group and skip-negative group. In order to establish the nomogram, univariate and multivariate analyses were used to estimate risk factors of skip metastases. The receiver operating characteristic (ROC) curve, internal calibration plot and decision curve analysis (DCA) were used to evaluate the nomogram model's efficacy.
There were statistical differences between skip-positive group and skip-negative group in tumor location, the maximum diameter (D) and capsule invasion (P<0.05). No statistical differences were observed in sex, age, Hashimoto's thyroiditis, multifocality, anteroposterior diameter/transverse diameter (A/T) ratio, shape, margin, microcalcification, intra-nodular vascularity and preoperative serum thyroglobulin (Tg) (P≥0.05). The risk factors of skip metastases in PTCs were D ≤10 mm, location in the upper portion and capsule invasion. The area under the curve (AUC) of nomogram was 0.877, the accuracy was 85.32%, the sensitivity was 60.98%, and the specificity was 90.96%. The calibration curve and the Hosmer-Lemeshow goodness of fit test showed that the consistency between the nomogram and the actual observation was good. The DCA showed that most PTC patients might benefit from the predictive nomogram model.
A nomogram for predicting skip metastases in PTCs may be useful in clinical diagnosis and treatment.
甲状腺乳头状癌（PTC）是最常见的内分泌恶性肿瘤。PTC的跳跃转移在手术前容易被误诊，这可能导致再次手术并影响预后。虽然有一些关于预测PTC中央淋巴结转移（CLNM）或侧方淋巴结转移（LLNM）的列线图研究，但关于跳跃转移的列线图研究较少。基于PTC患者的临床和超声特征，本研究的目的是探讨危险因素并建立一个预测PTC跳跃转移风险的列线图。
本研究纳入了218例伴有侧颈部淋巴结转移的PTC患者，并对其数据进行回顾性分析。根据术后病理结果，将患者分为跳跃转移阳性组和跳跃转移阴性组。为了建立列线图，采用单因素和多因素分析来评估跳跃转移的危险因素。采用受试者操作特征（ROC）曲线、内部校准图和决策曲线分析（DCA）来评估列线图模型的效能。
跳跃转移阳性组和跳跃转移阴性组在肿瘤位置、最大直径（D）和包膜侵犯方面存在统计学差异（P<0.05）。在性别、年龄、桥本甲状腺炎、多灶性、前后径/横径（A/T）比值、形态、边界、微钙化、结节内血管及术前血清甲状腺球蛋白（Tg）方面未观察到统计学差异（P≥0.05）。PTC跳跃转移的危险因素为D≤10mm、位于上部及包膜侵犯。列线图的曲线下面积（AUC）为0.877，准确率为85.32%，灵敏度为60.98%，特异度为90.96%。校准曲线和Hosmer-Lemeshow拟合优度检验表明列线图与实际观察结果之间的一致性良好。DCA表明大多数PTC患者可能从预测性列线图模型中获益。
预测PTC跳跃转移的列线图可能对临床诊断和治疗有用。
