摘要
Abstract
OBJECTIVE To identify factors associated with lymph node metastasis(LNM)in patients aged 55 years or older with papillary thyroid carcinoma(PTC)and to develop a prediction model incorporating thyroid autoantibodies,fibroblast growth factor 19(FGF19),and growth differentiation factor 15(GDF15).METHODS This retrospective study included 385 patients aged 55 years or older who underwent surgery for PTC at Wuhan Red Cross Hospital between November 2021 and December 2023.According to postoperative pathological findings,114 patients were assigned to the LNM group and 271 to the non-LNM group.Clinicopathological characteristics,thyroid autoantibodies,thyroid function indices,and serum FGF19 and GDF15 levels were compared.Multivariable logistic regression was used to identify independent factors and construct a prediction model,and receiver operating characteristic(ROC)analysis was performed to assess discrimination.RESULTS LNM occurred in 114 of 385 patients(29.61%).Tumor diameter≥1.5 cm,tumor location in the upper pole or isthmus,multifocality,capsular invasion,poor differentiation,TgAb≥500 U/ml,FGF19≥150 pg/ml,and GDF15≥500 ng/L were independently associated with LNM(all P<0.05).The model was:logit(P)=-4.352+0.693×tumor diameter≥1.5 cm+0.825×upper-pole or isthmus location+0.735×multifocality+0.806×capsular invasion+0.703×poor differentiation+0.783×TgAb≥500 U/ml+0.781×FGF19≥150 pg/ml+0.679×GDF15≥500 ng/L.The area under the ROC curve was 0.890(95%CI:0.856-0.924).At a predicted probability cutoff of 0.372,sensitivity was 82.5%and specificity was 81.2%.In the lateral cervical LNM subgroup,a lymph-node short-axis diameter≥5 mm,an indistinct margin,abundant vascularity,and cystic change or calcification were associated with metastasis.CONCLUSION Clinicopathological features and serum TgAb,FGF19,and GDF15 levels were associated with LNM in patients aged 55 years or older with PTC.The combined model showed good discriminatory ability for clinical risk stratification,but external multicenter validation is required.关键词
甲状腺肿瘤/乳头状甲状腺癌/淋巴结转移/甲状腺自身抗体/成纤维细胞生长因子19/生长分化因子15/预测模型Key words
Thyroid Neoplasms/Thyroid Cancer,Papillary/lymph node metastasis/thyroid autoantibodies/fibroblast growth factor 19/growth differentiation factor 15/prediction model
