基于弹性成像的列线图预测单发临床颈部淋巴结转移阴性甲状腺癌对侧中央淋巴结转移

An elastography-based nomogram for predicting contralateral central lymph node metastasis in patients with clinical lymph node negative single papillary thyroid carcinoma

目的:建立列线图预测模型于术前预测单发临床颈部淋巴结转移阴性(cN0)甲状腺乳头状癌(PTC)患者存在对侧中央淋巴结转移(CLNM)的风险。方法:选择297例单发cN0 PTC患者为研究对象,其中训练队列205例,验证队列92例,训练队列患者根据术后对侧中央淋巴结病理结果进行分组。分析患者的一般临床资料、超声、剪切波弹性(SWE)结果与对侧CLNM的关系,利用多因素Logistic回归筛选对侧CLNM的独立影响因素,基于各个独立因素建立列线图模型以预测对侧CLNM的风险,并通过内部和外部验证评价列线图的应用价值。结果:训练队列中,年龄、肿瘤大小、与包膜的距离、存在钙化、杨氏模量(YM)值是单发cN0 PTC患者对侧CLNM的独立影响因素(P值均<0.05)。基于以上影响因素建立的列线图预测模型在内部验证中表现出良好的区分度[曲线下面积(AUC)=0.934]及校准度(χ^(2)=5.263,P=0.729),其在基于验证队列的外部验证中亦表现出良好的区分度(AUC=0.824)及校准度(χ^(2)=7.252,P=0.384)。结论:基于临床特征、超声及弹性成像结果建立的列线图能实现单发cN0 PTC患者对侧CLNM的术前预测,有望为临床制定治疗方案提供指导意见。

Objective:To establish a nomogram for predicting the risk of contralateral central lymph node metastasis(CLNM)in patients with clinical lymph node negative(cN0)single papillary thyroid carcinoma(PTC).Methods:A total of 297 patients with single cN0 PTC were recruited,including 205 in the training cohort and 92 in the validation cohort.Patients in the training cohort were grouped according to the postoperative pathological results of contralateral central lymph node.The relationship between the general clinical data,ultrasound and shear wave elastography(SWE)results and contralateral CLNM was analyzed.Multivariate logistic regression was used to screen the independent influencing factors of contralateral CLNM.A nomogram model was established based on each independent factor to predict the risk of contralateral CLNM.The performance of the nomogram was evaluated by internal and external validation.Results:In the training cohort,age,tumor size,distance from tumor to thyroid capsule,calcification and Young's modulus(YM)value were independent influencing factors of contralateral CLNM in patients with single cN0 PTC(all P<0.05).The nomogram based on the above influencing factors showed good discrimination[area under the curve(AUC)=0.934]and calibration(χ^(2)=5.263,P=0.729)in the internal validation.It also showed good discrimination(AUC=0.824)and calibration(χ^(2)=7.252,P=0.384)in the external validation based on the validation cohort.Conclusion:The nomogram based on clinical characteristics,ultrasound and SWE can realize the preoperative prediction of contralateral CLNM in patients with single cN0 PTC,which is expected to guide the further clinical treatment.