甲状腺癌术后中央区淋巴结转移危险因素及预测模型构建

Risk factors and prediction model construction of central lymph node metastasis in thyroid cancer treated by surgery

目的探讨甲状腺癌术后中央区淋巴结转移危险因素并进一步构建相关预测模型,旨在为临床诊断及手术方案制定提供更多参考。方法回顾性纳入2021年1月至2023年6月在本院行腔镜手术治疗甲状腺癌患者193例,根据手术病理组织学结果是否证实为中央区淋巴结转移分为转移组(55例)和无转移组(138例),分析中央区淋巴结转移情况,采用单因素法和多因素法确定甲状腺癌术后中央区淋巴结转移独立危险因素,根据上述独立危险因素构建预测模型并描绘ROC曲线分析临床预测效能。结果单因素和多因素分析结果显示,TNM分期Ⅲ~Ⅳ期、肿瘤最大径≥2 cm、包膜浸润、微钙化及超声血流分级Ⅲ级均是甲状腺癌术后中央区淋巴结转移独立危险因素(P<0.05)。根据Logistic回归模型证实甲状腺癌术后中央区淋巴结转移独立危险因素,构建自变量偏回归系数模型方程式;ROC曲线分析结果显示,上述临床模型用于甲状腺癌术后中央区淋巴结转移风险预测曲线下面积为0.86(95%CI:0.83~0.95),最佳cut-off值为1.85,灵敏度和特异度分别为90.21%,82.90%。结论甲状腺癌术后中央区淋巴结转移与TNM分期、肿瘤最大径、包膜浸润情况、微钙化情况及超声血流分级等有关;而基于上述因素构建预测模型可用于中央区淋巴结转移风险预测。

Objective To investigate the risk factors of central lymph node metastasis in thyroid cancer treated by surgery and construct prediction model to provide more reference for clinical diagnosis and surgery plan.Methods From January 2021 to June 2023,193 patients with thyroid cancer treated by surgery were retrospectively studied.According to the histopathological results,all patients were divided into metastatic group(55 cases)and non-metastatic group(138 cases).The status of central lymph node metastasis was analyzed,and the independent risk factors for surgery for central lymph node metastasis were determined by univariate factor method and multivariate factor method.The prediction model was constructed according to the above independent risk factors and the ROC curve was described to analyze the clinical prediction efficiency.Results The results of univariate and multivariate analysis of Logistic regression model showed that TNM stageⅢtoⅣ,maximum tumor diameter≥2 cm,capsule invasion,microcalcification and ultrasonic blood flow gradeⅢwere independent risk factors for central lymph node metastasis of thyroid cancer undergoing surgery(P<0.05).The independent risk factors of surgery for central lymph node metastasis of thyroid cancer were confirmed by Logistic regression model,and the independent variable partial regression coefficient model equation was established.ROC curve analysis results showed that the area under the curve for predicting the risk of central lymph node metastasis in surgery for thyroid cancer was 0.86(95%CI:0.83~0.95),the optimal cut-off value was 1.85,and the sensitivity and specificity were 90.21%and 82.90%,respectively.Conclusion surgery for central lymph node metastasis of thyroid cancer is related to TNM stage,maximum tumor diameter,envelope infiltration,microcalcification and ultrasonic blood flow grade and the prediction model based on the above factors can be used to predict the central lymph node metastasis risk.