Duan Sensen, Yang Zhenyu, Wei Gang, Chen Songhao, Hu Xi'e, Ryu Young Jae, Yuan Lijuan, Bao Guoqiang
Department of General Surgery, the Second Affiliated Hospital of Air Force Medical University, Xi'an, China.
Department of Surgery, Chonnam National University Medical School, Jeonnam, Republic of Korea.
Gland Surg. 2024 Jun 30;13(6):1016-1030. doi: 10.21037/gs-24-154. Epub 2024 Jun 19.
A considerable controversy over performing thyroidectomy and central lymph node dissection in patients with papillary thyroid microcarcinoma (PTMC) remained. However, accurate prediction of central lymph node metastasis (CLNM) is crucial for surgical extent and proper management. The aim of this study was to develop and validate a practical nomogram for predicting CLNM in patients with PTMC.
A total of 1,029 patients with PTMC who underwent thyroidectomy and central lymph node dissection at Tangdu Hospital (the Second Affiliated Hospital of Air Force Medical University) and Xijing Hospital (the First Affiliated Hospital of Air Force Medical University) were selected. Seven hundred and nine patients were assigned to the training set and 320 patients to the validation set. Data encompassing demographic characteristics, ultrasonography results, and biochemical indicators were obtained. Stepwise backward selection and multiple logistic regression were used to screen the variables and establish the nomogram. Concordance index (C-index), receiver operating characteristic (ROC) curve analysis, and decision curve analysis (DCA) were employed to evaluate the nomogram's distinguishability, accuracy, and clinical utility.
Young age, multifocality, bigger tumor, presence of microcalcification, aspect ratio (height divided by width) ≥1, loss of fatty hilum, high free thyroxine (FT4), and lower anti-thyroid peroxidase antibody (TPOAb) were significantly associated with CLNM. The nomogram showed strong predictive capacity, with a C-index and accuracy of 0.784 and 0.713 in the training set and 0.779 and 0.703 in the external validation set, respectively. DCA indicated that the nomogram demonstrated strong clinical applicability.
We established a reliable, cost-effective, reproducible, and noninvasive nomogram for predicting CLNM in patients with PTMC. This tool could be a valuable guidance for deciding on management in PTMC.
对于甲状腺微小乳头状癌（PTMC）患者是否进行甲状腺切除术和中央区淋巴结清扫仍存在相当大的争议。然而，准确预测中央区淋巴结转移（CLNM）对于手术范围和恰当的治疗管理至关重要。本研究的目的是开发并验证一种用于预测PTMC患者CLNM的实用列线图。
选取了在唐都医院（空军军医大学第二附属医院）和西京医院（空军军医大学第一附属医院）接受甲状腺切除术和中央区淋巴结清扫的1029例PTMC患者。709例患者被分配到训练集，320例患者被分配到验证集。获取了包括人口统计学特征、超声检查结果和生化指标的数据。采用逐步向后选择法和多元逻辑回归筛选变量并建立列线图。采用一致性指数（C指数）、受试者工作特征（ROC）曲线分析和决策曲线分析（DCA）来评估列线图的区分能力、准确性和临床实用性。
年轻、多灶性、肿瘤较大、存在微钙化、纵横比（高度除以宽度）≥1、脂肪性 hilum 消失、游离甲状腺素（FT4）水平高和抗甲状腺过氧化物酶抗体（TPOAb）水平低与CLNM显著相关。列线图显示出较强的预测能力，训练集中C指数和准确性分别为0.784和0.713，外部验证集中分别为0.779和0.703。DCA表明列线图具有较强的临床适用性。
我们建立了一种可靠、经济有效、可重复且无创的列线图，用于预测PTMC患者的CLNM。该工具可为PTMC的治疗决策提供有价值的指导。
