单侧甲状腺乳头状癌中央区淋巴结转移的临床预测模型构建

Construction of clinical predictive model for central lymph node metastasis of unilateral papillary thyroid carcinoma

目的:探讨单侧甲状腺乳头状癌(PTC)发生中央区淋巴结转移的相关危险因素并构建临床预测模型,为单侧PTC的预防性中央区淋巴结清扫提供决策依据。方法:收集183例cN0单侧PTC病人的临床病理资料,分析预防性中央淋巴结清扫术后淋巴结转移的独立危险因素,并构建预测模型,将预测概率和真实值构建ROC曲线,分析该模型对于中央区淋巴结转移的预测效果。结果:多因素分析结果显示,男性、年龄<55岁、肿瘤最大径>1 cm及钙化是中央区淋巴结转移的独立危险因素。依据独立危险因素建立的预测模型:Logit(P)=-1.814+1.105×性别+0.953×年龄+0.707×肿瘤最大径+0.863×钙化形成;ROC曲线下面积为0.716(95%CI:0.641~0.790)。结论:建立的单侧cN0 PTC中央区淋巴结转移预测模型有较好的预测效果以及实用价值,可在术前使用该模型进行计算中央区淋巴结转移的概率,P值越大则淋巴结转移的风险越高,可进行预防性中央区淋巴结清扫。

Objective:To explore the risk factors of central lymph node metastasis in unilateral papillary thyroid carcinoma(PTC)and to establish a clinical predictive model to provide decision-making basis for preventive central lymph node dissection in unilateral PTC.Methods:The clinical and pathological data from 183 cN0 unilateral PTC patients were collected.The independent risk factors for lymph node metastasis after preventive central lymph node dissection were analyzed,and a predictive model was constructed.ROC curve based on the predicted probability and true value was constructed,and the predictive effect of the model on lymph node metastasis in the central region was analyzed.Results:Multivariate analysis showed that male,age<55 years,tumor diameter>1 cm,and calcification were independent risk factors for central lymph node metastasis.Prediction model based on independent risk factors:Logit(P)=-1.814+1.105×gender+0.953×age+0.707×tumor diameter+0.863×calcification.The area under the ROC curve was 0.716(95%CI:0.641-0.790).Conclusions:The prediction model has a good prediction effect and practical value of central lymph node metastasis for unilateral cN0 PTC.The model can be used to calculate the probability of central lymph node metastasis before operation.The higher the P value,the higher the risk of lymph node metastasis,and preventive central lymph node dissection should be performed.