全身性炎症指标和超声特征对cN0单侧甲状腺微小乳头状癌中央区淋巴结转移的预测价值

Prognostic Value of Systemic Inflammatory Indicators and UltrasoundFeatures in Central Lymph Node Metastasis of UnilateralThyroid Micropapillary Carcinoma of cN0

目的探讨术前全身炎症反应指数(SIRI)、全身免疫炎症指数(SII)、中性粒细胞计数/淋巴细胞计数(NLR)、血小板计数/淋巴细胞计数(PLR)、淋巴细胞计数/单核细胞计数(LMR)和超声特征对cN0单侧甲状腺微小乳头状癌(PTMC)中央区淋巴结转移的预测价值。方法回顾性分析2020年7月-2021年12月安徽理工大学第一附属医院收治的208例cN0单侧PTMC患者的临床资料,根据术后病理是否有中央区淋巴结转移分为转移组(n=64)和非转移组(n=144)。分析并比较两组患者术前SIRI、SII、NLR、PLR、LMR和超声特征间的差异。结果208例cN0的PTMC患者发生中央区淋巴结转移率为30.77%(64/208)。转移组和非转移组在年龄、边缘不清、微钙化、多病灶以及术前SIRI、SII、NLR、PLR、LMR相比差异无统计学意义(P>0.05)。转移组男性患者比例、肿瘤直径、紧贴包膜比例和丰富血流信号比例高于非转移组(P<0.05)。多因素Logistic回归分析发现,肿瘤直径、紧贴包膜和丰富血流信号是中央区淋巴结转移独立危险因素(P<0.05)。肿瘤直径、丰富血流信号和肿瘤直径联合丰富血流信号预测cN0单侧PTMC中央区淋巴结转移的ROC曲线下面积(AUC)分别为0.663(0.582-0.744)、0.668(0.591-0.746)和0.706(0.634-0.778)(P_均<0.001),肿瘤直径预测的截断值为0.55 cm。结论cN0单侧PTMC中央区淋巴结转移率较高,肿瘤直径>0.55 cm和丰富血流信号者需警惕淋巴结转移,两者联合可以提高预测能力。

Objective To investigate the preoperative systemic inflammatory response index(SIRI),systemic immunoinflammatory index(SII),neutrophil count/lymphocyte count(NLR),platelet count/lymphocyte count(PLR),lymphocyte count/monocyte count(LMR)and ultrasonic features of cN0 unilateral papillary thyroid carcinoma(PTMC)in central lymph Predictive value of junction transfer.Methods The clinical data of 208 patients with cN0 unilateral PTMC admitted to the First Affiliated Hospital of Anhui University of Science and Technology from July 2020 to December 2021 were retrospectively analyzed.The patients were divided into a metastasis group(n=64)and a non-metastasis group(n=144)according to whether there was central lymph node metastasis in postoperative pathology.Preoperative SIRI,SII,NLR,PLR,LMR and ultrasound features were compared between the two groups.Statistical analysis was performed using SPSS 19.0 software.T test was used to compare the normal distribution between the measurement data groups.Mann-Whitney U test was used to compare the non-normal distribution measurement data groups.Enumeration data were represented by example,and comparison between groups was performed by chi-square.Multivariate factor analysis was performed by binary Logistic regression analysis.Receiver Operating characteristic(ROC)curves were developed to predict risk factors for central lymph node metastasis,and area under the curve(AUC)was calculated.Results In 208 PTMC patients with cN0,the rate of central lymph node metastasis was 30.77%(64/208).There was no significant difference in unclear boundaries,microcalcification,multi-focus,SIRI,SII,NLR,PLR and LMR between the metastatic group and the non-metastatic group(P>0.05).In the metastatic group,the proportion of male patients,tumor diameter,proximity to envelope and enriched blood flow signal,the difference between the two groups was statistically significant(P<0.05).Multivariate Logistic regression analysis showed that tumor diameter,proximity to envelope and enriched blood flow signal were independent risk factors for central lymph node metastasis(P<0.05).The area under ROC curve(AUC)of tumor diameter,enriched blood flow signal and tumor diameter combined with enriched blood flow signal prediction of cN0 unilateral PTMC lymph node metastasis were 0.663(0.582-0.744),0.668(0.591-0.746)and 0.706(0.634-0.778),respectively(P<0.001),and the cutoff value of tumor diameter prediction was 0.55 cm.Conclusion The central lymph node metastasis rate of cN0 unilateral PTMC is high.Lymph node metastasis should be warned in patients with tumor diameter>0.55 cm and enriched blood flow signal,the combination of the two can improve predictive power.