Jiwang Liang, Dongman Ye, Fengqin Fang, Yuejiao Zhao
Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Head and Neck Surgery, Liaoning Province, China.
Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Department of Medical Imaging, Liaoning Province, China.
Braz J Otorhinolaryngol. 2025 Mar-Apr;91(2):101553. doi: 10.1016/j.bjorl.2024.101553. Epub 2025 Jan 3.
Differentiated thyroid cancers tend to excellent long-term survival after surgery. However, Locally Advanced Papillary Thyroid Cancers (LAPTCs) have poor prognosis. This study was to investigate the clinicopathologic features of LAPTC and the risk factors that affect its postoperative recurrence. We aimed to construct a nomogram to predict Recurrence-Free Survival (RFS) in LAPTC.
We retrospectively reviewed the data of patients who underwent surgery from 2011 to 2020 at a single institution. Univariate and multivariate analyses were used to investigate the clinicopathologic features of LAPTC. The risk factors that affecting recurrence of LAPTC were screened. The risk factors were subsequently integrated to establish a predictive model. C-index, receiver operating characteristic curve and calibration curve were used to validate the accuracy. A Decision Analysis Curve (DCA) was used to evaluate the clinical value.
A total of 2530 Early Papillary Thyroid Cancer (EPTC) and 764 LAPTC were enrolled. Compared to EPTC, the proportion of male, bilaterality, multifocality, tumor size > 1 cm, ETE, central lymph node metastasis, and lateral lymph node metastasis was higher in LAPTC (all p < 0.05). Univariate and multivariate analyses found that age ≥ 55-years-old, male, and ETE were independent risk factors for the LAPTC patients' RFS (all p < 0.05). C-index of the nomogram was 0.79. The AUC values of nomogram were 0.767 (95% CI 0.626‒0.909) and 0.798 (95% CI 0.669‒0.926) for 3- and 5-year RFS, respectively. The calibration curves of the nomogram showed good accuracy and consistency, and the DCA curves exhibited that the model had good clinical utility.
Male patients who with tumors tumor > 1 cm, bilaterality, multifocality, and ETE are more likely to become LAPTC. LAPTC patients with age ≥ 55-years-old, tumor size > 1 cm, and ETE are more likely to have postoperative recurrence. The model can help surgeons to predict 3- and 5-year RFS in LAPTC.
This article's evidence level is four. Level 4 evidence, the case series, comes in the form of a group of patients subjected to surgical procedure. Authors may detect a statistically significant and clinically relevant outcome.
分化型甲状腺癌术后长期生存率往往较好。然而，局部晚期甲状腺乳头状癌（LAPTC）预后较差。本研究旨在探讨LAPTC的临床病理特征及影响其术后复发的危险因素。我们旨在构建一个列线图来预测LAPTC的无复发生存期（RFS）。
我们回顾性分析了2011年至2020年在单一机构接受手术的患者数据。采用单因素和多因素分析来研究LAPTC的临床病理特征。筛选出影响LAPTC复发的危险因素。随后将这些危险因素整合以建立一个预测模型。使用C指数、受试者工作特征曲线和校准曲线来验证准确性。采用决策分析曲线（DCA）来评估临床价值。
共纳入2530例早期甲状腺乳头状癌（EPTC）和764例LAPTC。与EPTC相比，LAPTC中男性、双侧性、多灶性、肿瘤大小>1cm、甲状腺外侵犯（ETE）、中央淋巴结转移和侧方淋巴结转移的比例更高（均p<0.05）。单因素和多因素分析发现，年龄≥55岁、男性和ETE是LAPTC患者RFS的独立危险因素（均p<0.05）。列线图的C指数为0.79。列线图预测3年和5年RFS的AUC值分别为0.767（95%CI 0.626‒0.909）和0.798（95%CI 0.669‒0.926）。列线图的校准曲线显示出良好的准确性和一致性，DCA曲线表明该模型具有良好的临床实用性。
肿瘤>1cm、双侧性、多灶性且有ETE的男性患者更易成为LAPTC。年龄≥55岁、肿瘤大小>1cm且有ETE的LAPTC患者术后更易复发。该模型可帮助外科医生预测LAPTC的3年和5年RFS。
本文的证据水平为四级。四级证据，病例系列，以一组接受手术的患者为形式。作者可能检测到具有统计学意义和临床相关性的结果。
