伴中央区淋巴结转移的单侧甲状腺乳头状癌颈侧区淋巴结转移的预测模型

Predictive model of neck lateral lymph node metastasis in unilateral papillary thyroid cancer with central lymph node metastasis

目的建立伴中央区淋巴结转移(central lymph node metastasis,CLNM)的单侧甲状腺乳头状癌(unilateral papillary thyroid cancer,uni-PTC)患者发生颈侧区淋巴结转移(lateral lymph node metastasis,LLNM)的临床预测模型。方法本研究纳入2018年5月至2021年12月期间在解放军第九六〇医院甲状腺乳腺外科行甲状腺手术的uni-PTC且有CLNM的患者,按照7∶3比例随机分为建模组和验证组。运用单因素和logistic回归多因素分析影响伴CLNM的uni-PTC患者发生颈LLNM的风险因素,并以这些风险素构建列线图预测模型。运用受试者操作特征(receiver operating characteristic,ROC)曲线和校正曲线来验证性能。结果本研究共纳入237例患者,其中建模组158例、验证组79例,建模组中发生颈LLNM患者84例、验证组中发生颈LLNM患者43例。将建模组中单因素分析结果中有统计学意义的指标及既往研究认为的危险因素纳入进行logistic回归多因素分析,结果发现,病灶最大直径>1 cm、多发病灶、有腺外侵犯、CLNM率≥0.414、病灶位于甲状腺上极的伴CLNM的uni-PTC患者发生颈LLNM的概率增大(OR>1,P<0.05);以这些因素构建的列线图预测伴CLNM的uni-PTC患者发生颈LLNM的ROC曲线下面积为0.834[95%CI(0.771,0.896)],在验证组中ROC曲线下面积为0.761[95%CI(0.651,0.871)],建模组和验证组的校正曲线与理想线较接近。结论根据伴有CLNM的uni-PTC分析出发生颈LLNM的风险因素,以此为基础建立的临床风险预测模型能较好地预测它的发生概率。

Objective To establish a predictive model for neck lateral lymph node metastasis(LLNM)in unilateral papillary thyroid cancer(uni-PTC)with central lymph node metastasis(CLNM).Methods The uni-PTC patients with CLNM were included in this study.The patients underwent thyroid surgery in the 960th Hospital of the PLA Joint Logistics Support Force from May 2018 to December 2021,who were randomly divided into the modeling group and the validation group according to the ratio of 7∶3.The risk factors of neck LLNM were analyzed by univariate and multivariate logistic regression and the nomogram of prediction model was constructed.The receiver operating characteristic(ROC)curve and calibration curve were used to validate the prediction model.Results A total of 237patients were included in this study,including 158 patients in the modeling group and 79 patients in the validation group.The LLNM occurred in the 84 patients of the modeling group and 43 patients of the validation group.The multivariate logistic regression analysis was performed according to the statistical indicators in the univariate analysis results of the modeling group and the risk factors considered in the previous studies.The results showed that the patients with maximum diameter of the lesions>1 cm,multiple lesions,extraglandular invasion,the rate of CLNM≥0.414,and lesions located at the upper portion had higher probability of LLNM(OR>1,P<0.05).The area under ROC curve of the nomogram in predicting LLNM in the modeling group was 0.834[95%CI(0.771,0.896)],which in the validation group was 0.761[95%CI(0.651,0.871)].The calibration curve showed a good calibration degree in the prediction model.Conclusion The clinical risk prediction model established based on the risk factors can better predict the probability of LLNM.