大于10mm甲状腺乳头状癌侧颈区淋巴结转移预测

Prediction of lateral lymph node metastasis in papillary thyroid carcinoma larger than 10 mm

目的预测直径>10 mm(非T1a期)甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者侧颈区淋巴结转移(lateral lymph node metastasis,LLNM),并分析其转移模式。方法回顾性分析166例行甲状腺切除术合并侧颈区清扫术且病灶直径>10 mm的PTC患者资料;分析其临床病理特征及侧颈部各分区淋巴结转移模式。收集临床病理、超声特征及实验室检查结果等资料,利用单因素、多因素Logistic回归分析来评估与LLNM相关因素;在此结果上建立列线图模型,采用受试者工作特征(receiver operating characteristic,ROC)曲线评估其模型的准确性。结果LLNM最常见于Ⅲ区(38.1%),且两个区域转移模式(42.2%)最常见。当病灶位于腺体不同位置时,淋巴结转移模式差异无统计学意义(P>0.05)。多因素Logistic回归结果显示,病灶位置、游离三碘甲腺原氨酸(free triiodothyronine,FT3)、促甲状腺激素(thyroid stimulating hormone,TSH)、甲状腺过氧化物酶抗体(thyroid peroxidase antibodies,TPOAB)水平及中央区淋巴结转移(central lymph node metastasis,CLNM)数目均是LLNM的独立危险因素。列线图预测模型的曲线下面积为0.851,提示模型诊断准确度较高。结论基于临床病理、超声特征及实验室结果(CLNM数目、病灶位置、FT3、TSH及TPOAB水平)的列线图模型对预测直径>10 mm PTC患者LLNM表现良好,可用于临床应用指导。

Objective To predict the occurrence of lateral lymph node metastasis(LLNM)in papillary thyroid carcinoma(PTC)larger than 10 mm in diameter(non-T1A stage)and analyze the metastatic pattern.Methods A retrospective analysis was conducted on 166 PTC patients with the foci diameters larger than 10 mm who underwent thyroidectomy combined with lateral lymph node dissection.Clinicopathological characteristics were evaluated,and the occurrence and pattern of LLNM were analyzed.Univariate and multivariate Logistic regression analyses were used to assess the factors associated with LLNM.A nomogram model was established based on the results,and the receiver operating characteristic(ROC)curve was utilized to evaluate the model's accuracy.Results LLNM was most commonly observed in area-Ⅲ(38.1%),and the two-segment metastasis pattern was the most prevalent(42.2%).There was no significant difference in the pattern of LLNM when the lesions were located in different areas of the gland(P>0.05).Multivariate Logistic regression analysis revealed that the location of the lesion,levels of free triiodothyronine(FT3),thyroid-stimulating hormone(TSH),thyroid peroxidase antibodies(TPOAB),and the number of central lymph node metastasis(CLNM)were independent risk factors for LLNM.The area under the curve of the nomogram prediction model is 0.851,indicating a high level of diagnostic accuracy for the established model.Conclusion The nomogram model,incorporating clinicopathological and ultrasonic characteristics,and laboratory results(the number of CLNMs,location of the lesion,FT3,TSH,TPOAB levels),proves to be effective in predicting LLNM in PTCs larger than 10 mm and holds promise for clinical application.