基于超声特征的列线图预测甲状腺乳头状癌中央淋巴结转移

Prediction of central lymph node metastasis in papillary carcinoma of the thyroid by nomogram based on ultrasonographic features

目的:建立列线图预测模型于术前预测甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)患者出现颈部中央区淋巴结转移(central lymph node metastasis,CLNM)的风险,减少术后并发症的发生概率,达到精准治疗的目的。方法:选择364例PTC患者为研究对象,根据术后中央淋巴结病理学检查结果进行分组。收集患者的一般临床资料及超声资料,利用最小绝对收缩与选择算子(least absolute shrinkage and selection operator,LASSO)回归进行因素选择,多因素logistic回归筛选CLNM的独立影响因素,建立列线图模型以预测CLNM的风险,并通过内部验证评价列线图的应用价值。结果:多因素logistic回归分析示年龄<45岁、结节前后径超过1 cm、结节形态不规则、病灶多发、超声发现可疑淋巴结是PTC患者出现CLNM的独立影响因素(P<0.05)。根据多因素回归结果构建列线图预测模型,其在内部验证中表现出良好的区分度及校准度。列线图模型准确度(0.730,95%CI 0.681~0.775)较单一颈部淋巴结超声(0.638,95%CI 0.586~0.688)显著提高(P<0.001)。结论:基于临床及超声特征建立的列线图能实现PTC患者CLNM的术前预测,有望为临床制订治疗方案提供指导意见。

Objective:A nomogram prediction model was established to predict the risk of central lymph node metastasis(CLNM)of the neck in patients with papillary carcinoma of the thyroid(PTC)before surgery,so as to reduce the risk of postoperative complications and achieve the purpose of precise treatment.Methods:A total of 364 patients with PTC were selected as the research objects,and they were divided into groups according to the pathological results of the central lymph nodes after operation.The general clinical data and ultrasound data of patients were collected,and the factors were selected by using the least absolute shrinkage and selection operator(LASSO)regression.Multivariate logistic regression was used to screen independent influencing factors of CLNM.Then a nomogram model was established to predict the risk of CLNM,and the application value of nomogram through internal validation was evaluated.Results:Age<45 years old,nodule anteroposterior diameter over 1 cm,irregular nodule shape,multiple lesions,and suspicious lymph nodes detected by ultrasound were the independent influencing factors of CLNM in PTC patients(P<0.05).The CLNM risk nomogram prediction model showed good discrimination and calibration in internal validation,and its accuracy(0.730,95%CI 0.681-0.775)was better than preoperative cervical lymph node ultrasound(0.638,95%CI 0.586-0.688)significantly increased(P<0.001).Conclusion:The nomogram established based on clinical and ultrasound features can realize preoperative prediction of CLNM in PTC patients,and is expected to provide guidance for clinical treatment plan.