Department of Thyroid Surgery, Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Luzhou, 646000, Sichuan Province, China.
Operating Room of Affiliated Hospital of Southwest Medical University, Luzhou, China.
Clin Exp Metastasis. 2024 Oct;41(5):613-626. doi: 10.1007/s10585-024-10285-3. Epub 2024 Apr 3.
Central lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC) is common. In our study, we built a nomogram to predict CLNM. We retrospectively analyzed 1,392 PTC patients. This group of patients was divided into a training cohort (including 1,009 patients) and a validation cohort (including 383 patients). Analyses of the correlation between inflammatory indicators, ultrasonic characteristics, pathological characteristics and CLNM were conducted. In the training cohort and validation cohort, the metastatic rates of CLNM were 60.16% and 64.23%, respectively. Univariate and multivariate logistic regression analyses demonstrated that Hashimoto's thyroiditis (HT), calcification, multifocality, capsule invasion, PLR (platelet-lymphocyte ratio) ≤ 130.34, large tumors and middle and lower positions were independent risk factors for CLNM. Then, we constructed a nomogram. The nomogram had good discrimination regardless of whether there was CLNM, with a C-index of 0.809. The calibration curve indicated that the nomogram had good visual and quantitative consistency (p = 0.213). Decision curve analysis showed that the nomogram improved the net clinical benefit with a threshold probability of 0-82% in the training cohort and 0-71% in the validation cohort. We constructed a nomogram to predict CLNM in PTC and assist surgeons in making personalized clinical decisions for PTC.
甲状腺乳头状癌（PTC）的中央区淋巴结转移（CLNM）较为常见。在本研究中，我们构建了一个列线图来预测 CLNM。我们回顾性分析了 1392 例 PTC 患者。将这组患者分为训练队列（包括 1009 例患者）和验证队列（包括 383 例患者）。分析了炎症指标、超声特征、病理特征与 CLNM 之间的相关性。在训练队列和验证队列中，CLNM 的转移率分别为 60.16%和 64.23%。单因素和多因素 logistic 回归分析表明，桥本甲状腺炎（HT）、钙化、多灶性、包膜侵犯、血小板淋巴细胞比值（PLR）≤130.34、肿瘤较大以及中下部位置是 CLNM 的独立危险因素。然后，我们构建了一个列线图。该列线图在有无 CLNM 时均具有良好的区分度，C 指数为 0.809。校准曲线表明，该列线图具有良好的视觉和定量一致性（p=0.213）。决策曲线分析显示，在训练队列和验证队列中，该列线图在阈值概率为 0-82%和 0-71%时提高了净临床获益。我们构建了一个预测 PTC 患者 CLNM 的列线图，以帮助外科医生为 PTC 患者做出个性化的临床决策。
