Yang Huaiyu, Wei Liyuan, Qian Jiaxin, Liu Wensheng
Department of Head and Neck Surgical Oncology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Oncol. 2025 May 21;15:1586307. doi: 10.3389/fonc.2025.1586307. eCollection 2025.
With the increasing prevalence of papillary thyroid carcinoma PTC) and advancements in auxiliary examination technology, the holistic detection rate of malignant thyroid nodules, particularly small ones, continues to rise. However, there remains controversy surrounding the optimal treatment for PTC, and a crucial factor influencing treatment decisions is the status of central lymph node metastasis (CLNM). There is a lack of research on the relationship between clinical laboratory results and tumor characteristics observed during surgery and CLNM status. Therefore, our research aims to systematically explore the risk factor of CLNM in patients with PTC.
We systematically gathered and analyzed clinical features and pathological data of 2,435 PTC patients who underwent surgery. After variable screening, the selected variables were included in logistic regression analysis, and a Nomogram prediction model was constructed according to the analysis results. To investigate the risk factors for CLNM in patients with PTC.
This study included a total of 2,435 patients diagnosed with PTC, among whom 933 patients were confirmed as CLNM by postoperative pathology. Univariate and multivariate regression analysis identified age, serum TRAb levels, calcification, multifocality, extrathyroidal invasion, tumor size, and tumor location as risk factors associated with CLNM. The prediction model based on these risk factors demonstrated robust accuracy with an AUC of 0.76. Clinical decision curve analysis indicated that aside from a small range of low threshold probabilities, intervening based on the model's predictions can yield greater clinical benefit.
Key risk factors for CLNM in PTC patients include young age, high serum thyrotropin receptor antibody (TR-Ab) levels, calcification, multifocality, extrathyroidal extension, larger tumor size, and tumor location in the middle or lower poles of the thyroid. The clinical prediction model established based on these critical risk factors can provide a more accurate reference standard for clinical decision-making in practice.
随着甲状腺乳头状癌（PTC）患病率的上升以及辅助检查技术的进步，甲状腺恶性结节尤其是小恶性结节的整体检出率持续提高。然而，PTC的最佳治疗方案仍存在争议，影响治疗决策的一个关键因素是中央淋巴结转移（CLNM）状态。目前缺乏关于临床实验室检查结果与手术中观察到的肿瘤特征及CLNM状态之间关系的研究。因此，我们的研究旨在系统探讨PTC患者CLNM的危险因素。
我们系统收集并分析了2435例接受手术的PTC患者的临床特征和病理数据。经过变量筛选，将选定的变量纳入逻辑回归分析，并根据分析结果构建列线图预测模型，以研究PTC患者CLNM的危险因素。
本研究共纳入2435例确诊为PTC的患者，其中933例患者术后病理证实存在CLNM。单因素和多因素回归分析确定年龄、血清促甲状腺素受体抗体（TRAb）水平、钙化、多灶性、甲状腺外侵犯、肿瘤大小和肿瘤位置为与CLNM相关的危险因素。基于这些危险因素的预测模型显示出强大的准确性，曲线下面积（AUC）为0.76。临床决策曲线分析表明，除了一小部分低阈值概率外，基于模型预测进行干预可产生更大的临床益处。
PTC患者CLNM的关键危险因素包括年轻、血清促甲状腺素受体抗体（TR-Ab）水平高、钙化、多灶性、甲状腺外扩展、肿瘤较大以及肿瘤位于甲状腺中极或下极。基于这些关键危险因素建立的临床预测模型可为临床实践中的决策提供更准确的参考标准。
