超声在桥本甲状腺炎合并PTC患者5年复发情况预测中的应用价值

The application value of ultrasound in predicting the 5-year recurrence of patients with papillary carcinoma of the thyroid combined with Hashimoto’s thyroiditis

目的:探讨超声在预测桥本甲状腺炎(Hashimoto’s thyroiditis,HT)合并甲状腺乳头状癌(papillary carcinoma of the thyroid,PTC)患者(以下简称HTPTC)术后5年复发情况中的应用价值,并建立预测模型。方法:收集并分析292例经手术治疗的HTPTC患者的超声及临床资料,记录患者复发情况,中位随访时间5.42年,复发定义为经细针穿刺活检(fine-needle aspiration biopsy,FNAB)或二次手术后的病理学检查确诊新病灶或异常淋巴结中存在癌细胞。采用单因素Cox回归分析确定与5年复发相关的潜在预测因素,纳入多因素Cox回归分析,识别出与复发相关的独立预测因素,构建并评估预测模型。结果:Cox单因素回归分析结果显示结节最大径、形状、边缘、钙化情况、超声血流情况、恶性结节数量、接触被膜情况是与5年复发相关的潜在预测因素。Cox多因素回归分析结果证实,结节最大径>1.5 cm[HR=3.37(95%CI 1.17~9.68),P=0.023]、结节纵横比>1[HR=4.82(95%CI 1.69~13.75),P=0.003]、微钙化[HR=5.51(95%CI 1.18~25.68),P=0.029]及恶性结节多灶[HR=3.28(95%CI 1.03~10.47),P=0.045]是HTPTC患者5年复发的独立预测因素,应用以上变量建立HTPTC患者复发的预测模型,该模型的C指数为0.845(标准误=0.061),第3年的受试者工作特征(receiver operating characteristic,ROC)曲线的曲线下面积为0.767(95%CI 0.502~1.000),第5年为0.834(95%CI 0.695~0.943)。结论:基于超声特征的预测模型为HTPTC患者的复发风险评估提供了新的方法,有助于医师在术前为患者制订个性化治疗方案,以减少过度治疗。

Obejetive:To investigate the value of ultrasound in predicting the 5-year postoperative recurrence of patients with Hashimoto’s thyroiditis(HT)combined with papillary carcinoma of the thyroid(PTC),hereinafter referred to as HTPTC,and to establish a prediction model.Methods:The ultrasound and clinical data of 292 HTPTC patients treated surgically were collected and analyzed.The recurrence of patients was recorded,with a median follow-up time of 5.42 years.Recurrence was defined as the presence of cancer cells in new lesions or abnormal lymph nodes confirmed by fine-needle aspiration biopsy(FNAB)or pathology results after a second surgery.Univariate Cox regression analysis was used to determine potential predictors related to 5-year recurrence,which were then included in a multivariate Cox regression analysis to identify independent predictors of recurrence and to construct and evaluate a prediction model.Results:The multivariate Cox regression analysis confirmed that a nodule maximum diameter greater than 1.5 cm(HR=3.37,95%CI 1.17-9.68,P=0.023),a nodule aspect ratio greater than 1(HR=4.82,95%CI 1.69-13.75,P=0.003),microcalcification(HR=5.51,95%CI 1.18-25.68,P=0.029),and multifocal malignant nodules(HR=3.28,95%CI 1.03-10.47,P=0.045)were independent predictors of 5-year recurrence in HTPTC patients.Using these variables,a prediction model for recurrence in HTPTC patients was established.The C-index of the model was 0.845(SE=0.061).The area under the receiver operating characteristic(ROC)curve was 0.767(95%CI 0.502-1.000)for the third year and 0.834(95%CI 0.695-0.943)for the fifth year.Conclusion:The ultrasound-based predictive model provides a new method for assessing the recurrence risk in HTPTC patients,aiding doctors in personalizing preoperative planning for patients to reduce overtreatment.