肿瘤预防与治疗2025，Vol.38Issue(12)：1083-1090,8.DOI:10.3969/j.issn.1674-0904.2025.12.007
单侧叶甲状腺乳头状癌喉前淋巴结转移的危险因素及风险预测模型构建
Risk Factors for Delphian Lymph Node Metastasis and Development of a Risk Prediction Model in Unilateral Papillary Thyroid Carcinoma
摘要
Abstract
Objective:To identify the risk factors for Delphian lymph node(DLN)metastasis in unilateral papillary thyroid carcinoma(PTC)and to develop and validate a risk prediction model for DLN moetastasis in these patients.Meth-ods:We enrolled PTC patients who underwent thyroid surgery at our hospital between January 2024 and May 2025 and retrospectively collected their clinical data.The patients were ran-domly assigned at a 2:1 ratio to either the modeling cohort(n=100)or the validation cohort(n=50).Patients were categorized into DLN metastasis(n=45)and non-metastasis(n=105)groups.Of the 45 patients with metastasis,27 were in the modeling cohort and 18 in the validation cohort.Patient data were collected for subsequent analysis and model development.A multivariable logistic regression analysis was performed to analyze the risk factors for DLN metastasis in PTC patients.A nomogram for predicting DLN metastasis in PTC patients was constructed and validated.The model's goodness-of-fit was assessed using the Hosmer-Lemeshow test,while its predictive performance was examined with ROC curves.Addi-tionally,calibration curves were used to analyze the model's accuracy,and decision curve analysis was employed to evaluate its clinical utility.Results:In the modeling cohort,significant differences were observed in baseline characteristics between patients with and without DLN metastasis.These variables included age,tumor location,tumor number,tumor diameter,capsular invasion,adjacent muscle invasion,central lymph node metastasis,BRAF mutation status,and anti-thyroglobulin antibody levels(statistical values:3.310,9.441,2.560,10.074,8.843,14.775,5.939,-1.292;all P<0.05).LASSO regression analysis incorporated three variables:age,tumor number,and central lymph node metastasis.Among these,age and central lymph node metastasis were identified as independent risk factors for DLN metastasis in PTC patients(OR=-0.82 and 2.14,respectively;P<0.05).The probability in the risk prediction model was given by P=1/[1+e(1.85-0.82×(age)+2.14×(central lymph node metastasis)],and the Hosmer-Lemeshow test indicated a good fit(χ2=9.544,P=0.126).ROC analysis revealed that the model achieved an AUC of 0.820(95%CI:0.731～0.890)in the modeling group,with a sensitivity of 85.19%and a specificity of 65.75%.In the validation group,the model's AUC was 0.805(95%CI:0.668～0.903),with a sensitivity of 88.89%and a specificity of 78.12%.The calibration curve demonstrated that the model's predictions were close to the ideal line.The decision curve showed that the model provided the highest net benefit when the threshold probability was between 0.02 and 0.99.Conclusion:The prediction model for DLN metastasis,developed based on identified risk factors in PTC patients,demonstrated favourable performance with good calibration,sensitivity,and speci-ficity.Its clinical application shows potential for identifying high-risk individuals and provides a reliable basis for future stud-ies with larger cohorts.关键词
甲状腺乳头状癌/喉前淋巴结/淋巴结转移/预测模型/LASSO回归/列线图/受试者特征曲线Key words
Papillary thyroid carcinoma/Delphian lymph node/Lymph node metastasis/Prediction model/LASSO re-gression/Nomogram/Receiver operating characteristic curve分类
医药卫生引用本文复制引用
Guo Guanjun,Wang Xianzhu,Wu Yongliang,Xu Wenwei..单侧叶甲状腺乳头状癌喉前淋巴结转移的危险因素及风险预测模型构建[J].肿瘤预防与治疗,2025,38(12):1083-1090,8.基金项目
This study was supported by grants from Foshan Science and Technology Bureau(No.2320001006350). 佛山市自筹经费类科技创新项目(编号:2320001006350) （No.2320001006350）
