Department of Medical Administration, Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University, Urumqi, China.
Department of Big Data, College of Information Engineering, Xinjiang Institute of Engineering, Urumqi, China.
Front Endocrinol (Lausanne). 2024 Oct 28;15:1395900. doi: 10.3389/fendo.2024.1395900. eCollection 2024.
The treatment for papillary thyroid microcarcinoma (PTMC) is controversial. Central lymph node metastasis (CLNM) is one of the main predictors of recurrence and survival, accurate preoperative identification of CLNM is essential for surgical protocol establishment for PTMC. The objective of this study was to establish a nomogram to predict the possibility of CLNM in PTMC patients.
A total of 3023 PTMC patients were randomly divided into two groups by a ratio of 7 to 3, the training group (n = 2116) and validation group (n = 907). The LASSO regression model and multivariate logistic regression analysis were performed to examine risk factors associated with CLNM. A nomogram for predicting CLNM was established and internally validated. Meanwhile, we follow-up the serum thyroid function FT3, FT4, TSH, Tg, TGAb and TPOAb in 789 PTMC patients for 4 years after surgery and compared the differences between the CLNM (+) and CLNM (-) groups, respectively.
The LASSO regression model and multivariate logistic regression analysis showed that younger age, lower BMI, being male, location in the lower pole, calcification, 1 ≥ diameter ≥ 0.5 cm, multifocality lesions, extra thyroidal extension (ETE), enlargement of central lymph node (ECLN), lateral lymph node metastasis (LLNM) and higher carcinoembryonic antigen were the ultimate risk factors for determining CLNM. A nomogram for predicting CLNM was constructed based on the influencing factors and internally validated. By establishing the prediction model, the AUC of CLNM in the training and validation groups were 0.73 (95% CI, 0.70-0.76) and 0.75 (95% CI, 0.71-0.79) respectively. Results of the DCA showed that the model is clinically useful when deciding on intervention in the most range of the threshold probability. A 4-year follow-up of thyroid function showed that FT3 and FT4 remained at stable levels after 3 months postoperative and were higher in the CLNM (+) group than in the CLNM (-) group. Hypothyroidism appeared predominantly within 3 months after surgery. The overall incidence of the CLNM (+) group and CLNM (-) groups were 16.46% and 12.04%, respectively.
The nomogram model constructed in this study has a good predictive effect on CLNM in PTMC patients and provides a reasonable reference for clinical treatment.
甲状腺微小乳头状癌（PTMC）的治疗存在争议。中央区淋巴结转移（CLNM）是复发和生存的主要预测因素之一，因此准确预测 CLNM 对制定 PTMC 的手术方案至关重要。本研究旨在建立预测 PTMC 患者 CLNM 可能性的列线图。
将 3023 例 PTMC 患者按 7:3 的比例随机分为两组，即训练组（n=2116）和验证组（n=907）。采用 LASSO 回归模型和多因素 logistic 回归分析筛选与 CLNM 相关的危险因素。建立预测 CLNM 的列线图，并进行内部验证。同时，对 789 例 PTMC 患者术后 4 年的血清甲状腺功能 FT3、FT4、TSH、Tg、TGAb 和 TPOAb 进行随访，并比较 CLNM（+）和 CLNM（-）组之间的差异。
LASSO 回归模型和多因素 logistic 回归分析显示，年龄较小、BMI 较低、男性、下极位置、钙化、直径 1≥0.5cm、多灶性病变、甲状腺外侵犯（ETE）、中央区淋巴结肿大（ECLN）、侧区淋巴结转移（LLNM）和癌胚抗原升高是 CLNM 的最终危险因素。基于这些影响因素建立了 CLNM 预测列线图，并进行了内部验证。在训练组和验证组中，CLNM 的 AUC 分别为 0.73（95%CI，0.70-0.76）和 0.75（95%CI，0.71-0.79）。DCA 结果表明，在阈值概率的最宽范围内进行干预时，该模型具有临床应用价值。4 年的甲状腺功能随访结果显示，术后 3 个月后 FT3 和 FT4 保持稳定水平，CLNM（+）组高于 CLNM（-）组。术后 3 个月内主要出现甲状腺功能减退。CLNM（+）组和 CLNM（-）组的总体发生率分别为 16.46%和 12.04%。
本研究建立的列线图模型对预测 PTMC 患者的 CLNM 具有良好的预测效果，为临床治疗提供了合理的参考。
