术前NLR、TSH检测预测甲状腺乳头状癌侧区淋巴结转移风险的应用价值

Application Value of Preoperative NLR and TSH in Predicting the Risk of Lymph Node Metastasis in the Lateral Region of Papillary Thyroid Cancer

目的探讨术前中性粒细胞与淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、促甲状腺激素(thyroid stimulating hormone,TSH)在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)预测颈外侧区淋巴结转移风险的价值。方法分析654例PTC患者的临床资料,NLR、TSH及其他血清学指标通过受试者工作特征(receiver operating characteristic,ROC)曲线获得连续变量的截断值。进行二元Logistic回归分析,将独立危险因素纳入Logistic回归模型中,建立列线图。采用C指数及校准曲线评价预后模型的准确性和区分度。采用临床决策分析(clinical decision analysis,DCA)曲线来预测临床应用潜力。结果多因素Logistic回归分析结果显示,术前NLR、TSH、Tg/TSH、T分期、肿瘤灶数为影响PTC患者颈外侧区淋巴结转移的独立危险因素(P<0.05),并构建列线图,C指数为0.730,对该模型进行验证,C指数为0.719,其校准曲线有较好的一致性,DCA曲线表明了良好的临床潜力。结论术前NLR低值组、TSH高值组联合临床其他因素对预测PTC颈外侧区淋巴结转移有重要预测价值。

Objective To investigate the application value of preoperative neutrophil-to-lymphocyte ratio(NLR)and thyroid stimulating hormone(TSH)in predicting the risk of lymph node metastasis in the lateral cervical region in papillary thyroid cancer(PTC).Methods Clinical data of 654 patients with PTC were analyzed,and cut-off values for NLR,TSH,and other serological indices were obtained by receiver operating characteristic(ROC)curves for continuous variables.Binary Logistic regression analysis was performed,and independent risk factors were included in the Logistic regression model to establish a nomogram.The accuracy and discrimination of the prognostic model were evaluated using C-index and calibration curves.Clinical decision analysis(DCA)curve were used to predict the potential for clinical application.Results The results of multivariate Logistic regression analysis showed that preoperative NLR,TSH,Tg/TSH,T stage,and number of tumor foci were the independent risk factors affecting lymph node metastasis in the lateral neck region of PTC patients(P<0.05),and a nomogram was constructed with a C-index of 0.730,and the model was validated with a C-index of 0.719,and its calibration curve had good agreement,and the DCA curve indicated a good clinical potential.Conclusion The preoperative NLR low value group and TSH high value group combined with other clinical factors have significant predictive value in predicting lymph node metastasis in the lateral cervical region of PTC.