中国耳鼻咽喉头颈外科2024，Vol.31Issue(6)：351-355,5.DOI:10.16066/j.1672-7002.2024.06.003
甲状腺乳头状癌被膜侵犯患者中央区淋巴结转移风险因素列线图预测模型的建立及验证
To establish and validate a nomogram prediction model for the risk factors of central lymph node metastasis in patients with capsular invasion of papillary thyroid carcinoma
摘要
Abstract
OBJECTIVE To investigate the related factors of central lymph node metastasis(CLNM)in papillary thyroid carcinoma(PTC)with capsular invasion,and to construct a clinical nomogram prediction model.Its purpose is to provide theoretical basis for clinical diagnosis and treatment.METHODS The clinical data of PTC patients with capsule invasion admitted to the Department of General Surgery,Baoding First Central Hospital from October,2020 to October,2023 were retrospectively analyzed.The data included gender,age,body mass index(BMI),aspect ratio,tumor location,multifocality,microcalcification,Hashimoto thyroiditis(HT)and tumor diameter.According to the presence or absence of CLNM,the patients were divided into the normal group(107 cases)and the metastasis group(108 cases).Univariate and multivariate analysis of the data were performed to construct a visual nomogram prediction model,and the receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic efficacy of the model.The nomogram model was internally verified using a Bootstrap test with 1000 repeated samples.Consistency index(C-index)and calibration curve were used to describe the prediction performance and prediction accuracy of the model.Finally,the clinical decision curve(DCA)was drawn to determine the clinical application ability of the model.RESULTS A total of 215 PTC patients with capsular invasion were included,of whom 108(50.23%)had CLNM.Univariate analysis showed that the occurrence of CLNM was associated with tumor diameter,aspect ratio>1,tumor located in the lower pole,multifocality,and HT(P<0.05).Multivariate regression analysis showed that tumor diameter,aspect ratio>1,tumor located in the lower pole and multifocus were independent risk factors for CLNM(OR=1.401,1.875,2.291,2.303,P<0.05),and HT was a protective factor for CLNM(OR=0.501,P<0.05).Based on the above risk factors,a nomogram prediction model for CLNM in patients with PTC with capsule invasion was constructed.The ROC curves showed that the area under the curve(AUC)was 0.859(95%CI:0.792-0.925,Yoden Index was 0.734,the sensitivity was 0.878,a specificity was 0.856),and the model had higher predictive value.Internal validation consistency index(C-index)was 0.83(95%CI,0.748 to 0.959).The calibration curve showed that the predictive value was close to the ideal curve,and it had good consistency.The DCA curve showed that the model had good clinical efficacy.CONCLUSION Larger tumor size,aspect ratio>1,tumor located in the lower pole and multifocality suggest higher risk of CLNM in PTC with capsular invasion,while HT is a protective factor for CLNM.The nomogram model based on the above risk factors has high discrimination and calibration,which is helpful for clinicians in preoperative evaluation and intraoperative exploration,so that high-risk patients can be prevented and treated as soon as possible.关键词
甲状腺肿瘤/危险因素/列线图/被膜侵犯/淋巴结转移/预测模型Key words
Thyroid Neoplasms/Risk Factors/Nomograms/capsular invasion/lymph node metastasis/prediction model引用本文复制引用
张天昊,郝志伟,安杰,李金,李锦行,姜战武..甲状腺乳头状癌被膜侵犯患者中央区淋巴结转移风险因素列线图预测模型的建立及验证[J].中国耳鼻咽喉头颈外科,2024,31(6):351-355,5.基金项目
保定市科技计划项目(2141ZF076) （2141ZF076）
