基于临床、超声及基因特征列线图预测甲状腺乳头状癌侵袭性

Nomogram based on clinical,ultrasonic and genetic characteristics for predicting invasiveness of papillary thyroid carcinoma

目的观察基于临床、超声及基因特征的列线图预测甲状腺乳头状癌(PTC)侵袭性的价值。方法回顾性分析207例PTC患者,根据术后病理所示病灶侵及甲状腺被膜和/或发生患侧颈部淋巴结转移与否分为侵袭组(n=130)及非侵袭组(n=77);对比2组临床、超声及基因特征,筛选PTC侵袭性的危险因素,并以之建立列线图模型,观察其预测PTC侵袭性风险的价值。结果2组患者年龄,结节最大径、与被膜直线距离、微钙化、数目和分布,以及BRAF V600E基因检测差异均有统计学意义(P均<0.05)。结节最大径>1 cm[OR=2.540,95%CI(1.341,4.810),P=0.004]、微钙化[OR=2.276,95%CI(1.203,4.308),P=0.011]、双侧叶多灶[OR=3.414,95%CI(1.578,7.385),P=0.002]及突变型BRAF V600E[OR=2.663,95%CI(1.147,6.182),P=0.023]为PTC侵袭性的独立危险因素。列线图模型预测PTC侵袭性的曲线下面积为0.747[95%CI(0.679,0.815)]。结论以基于结节最大径、微钙化、数目和分布及BRAF V600E基因检测的列线图预测PTC侵袭性具有一定价值。

Objective To observe the value of nomogram based on clinical,ultrasonic and genetic characteristics for predicting invasiveness of papillary thyroid carcinoma(PTC).Methods Data of 207 PTC patients were retrospectively analyzed.The patients were divided into invasive group(n=130)and non-invasive group(n=77)according to invaded thyroid capsule and/or cervical lymph node metastasis on the affected side showed of postoperative pathology.The clinical,ultrasonic and genetic characteristics were observed between groups to screen the risk factors of PTC invasiveness.Then the nomogram model was established,and its value for predicting the invasiveness of PTC was observed.Results There were significant differences of age,the maximum diameter,linear distance from capsule,micro-calcification,number and distribution of nodule and BRAF V600E gene detection between groups(all P<0.05).The maximum diameter>1 cm(OR=2.540,95%CI[1.341,4.810],P=0.004),micro-calcification(OR=2.276,95%CI[1.203,4.308],P=0.011),bilateral lobe multifocal lesions(OR=3.414,95%CI[1.578,7.385],P=0.002)and mutant BRAF V600E(OR=2.663,95%CI[1.147,6.182],P=0.023)were all independent risk factors for PTC invasiveness.The area under the curve of nomogram model for predicting the invasive risk of PTC was 0.747(95%CI[0.679,0.815]).Conclusion Nomogram based on the maximum diameter,micro-calcification,number and distribution of nodules and BRAF V600E gene detection had a certain value for predicting invasiveness of PTC.