基于不同淋巴结分期系统的风险竞争模型在分化型甲状腺癌中的应用及亚组分析。

Application and subgroup analysis of competing risks model based on different lymph node staging systems in differentiated thyroid cancer.

机构信息

Department of Thyroid Surgery, The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha City, Hunan Province, China.

出版信息

Updates Surg. 2024 Sep;76(5):1927-1947. doi: 10.1007/s13304-024-01851-1. Epub 2024 May 1.

Abstract

Differentiated thyroid cancer (DTC) is the most common endocrine malignancy, with a rising incidence worldwide. Accurate prognostic models are essential for effective patient management. This study evaluates the prognostic value of various lymph node staging systems in DTC using a competing risks model. We used SEER database records (1998-2016) of 16,527 DTC patients, analyzing N stage, positive lymph node numbers (PLNNs), metastatic lymph node ratio (MLNR), log odds of positive lymph nodes (LODDS), and log odds of the negative lymph node (NLN)/T stage ratio (LONT). Univariate and multivariate analyses in a competing risks model were performed, along with subgroup analyses based on demographic and clinical characteristics. In this study of 16,527 patients with DTC, different lymph node staging systems showed different prognostic correlations in univariate and multivariate analyses. In particular, PLNNs showed significant prognostic correlations in several subgroups. Additionally, PLNNs were more suitable as a lymph node staging system for DTC than LODDS and MLNR in N1 stage subgroups, with an optimal cut-off of 13. Receiver operating characteristic curves, calibration curves and nomograms improved the clinical utility of the prognostic model based on PLNNs. Using competing risks model and subgroup analyses, we found that PLNNs had the best prognostic discriminatory efficacy for patients with DTC, especially those with N1 stage disease, and had an optimal cut-off value of 13.

摘要

甲状腺分化癌(DTC)是最常见的内分泌恶性肿瘤,全球发病率呈上升趋势。准确的预后模型对于有效的患者管理至关重要。本研究使用竞争风险模型评估了各种淋巴结分期系统在 DTC 中的预后价值。我们使用了 SEER 数据库(1998-2016 年)中 16527 名 DTC 患者的记录,分析了 N 分期、阳性淋巴结数量(PLNNs)、转移淋巴结比(MLNR)、阳性淋巴结对数比值(LODDS)和阴性淋巴结/肿瘤分期比(LONT)的对数比值。在竞争风险模型中进行了单变量和多变量分析,并根据人口统计学和临床特征进行了亚组分析。在这项对 16527 名 DTC 患者的研究中,不同的淋巴结分期系统在单变量和多变量分析中显示出不同的预后相关性。特别是 PLNNs 在几个亚组中表现出显著的预后相关性。此外,PLNNs 比 LODDS 和 MLNR 更适合作为 N1 期亚组的 DTC 淋巴结分期系统,最佳截断值为 13。受试者工作特征曲线、校准曲线和列线图提高了基于 PLNNs 的预后模型的临床实用性。使用竞争风险模型和亚组分析,我们发现 PLNNs 对 DTC 患者具有最佳的预后区分能力,尤其是对 N1 期疾病患者,最佳截断值为 13。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索