基于临床和超声特征预测甲状腺微小乳头状癌中央淋巴结转移的Nomogram

A Nomogram based on clinical and ultrasound characteristics to predict central lymph node metastases of papillary thyroid microcarcinoma

目的:中央区淋巴结的状态对于确定甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的手术策略至关重要。本研究旨在开发用于预测中央淋巴结转移(central lymph node metastases,CLNM)的Nomogram。方法:回顾性分析2019年7月至2020年11月在常州市第一人民医院行甲状腺切除和中央区淋巴结清扫的PTMC患者。将患者随机分为“建模组”和“验证组”。在建模组中行单变量和多变量分析以确定CLNM的危险因素。开发了用于预测CLNM的Nomogram,并对其进行了内部和外部验证。结果:Nomogram中纳入与CLNM相关的独立危险因素(性别、瘤体最大直径、病灶数目、纵横比、边缘)。校正曲线显示Nomogram与实际临床观察的CLNM具有较好的一致性。Nomogram在建模组和验证组中的曲线下面积分别为0.759和0.757。结论:Nomogram可以在术前客观量化CLNM的风险。临床医生可以用此来评估PTMC患者的淋巴结状态,并考虑对高危患者进行预防性中央区淋巴结清扫。

Objective:To develop a Nomogram for predicting central lymph node metastases(CLNM)for that the status of central lymph nodes is important for determining the surgical strategy of papillary thyroid microcarcinoma(PTMC).Methods:PTMC patients who underwent thyroidectomy and central neck dissection in The First People’s Hospital of Changzhou from July 2019 to November2020 were retrospectively retrieved. These patients were randomly divided into“modeling group”and“validation group”. Univariate and multivariate analyses were performed in the modeling group to determine the risk factors for CLNM. The Nomogram used to predict CLNM was developed and verified internally and externally.Results:Independent risk factors related to CLNM(gender,maximum tumor diameter,number of lesions,aspect ratio,and margin)were included in the Nomogram. The calibration curve showed that the Nomogram was in good agreement with the CLNM prediction of actual clinical observation. The area under the curve of the Nomogram in the modeling group and the verification group were 0.759 and 0.757,respectively.Conclusion:The Nomogram can objectively quantify the possibility of CLNM before surgery. Clinicians can use this model to assess the lymph node status of patients with PTMC and consider prophylactic central neck dissection in high-risk patients.