外科理论与实践2026，Vol.31Issue(4)：306-318,13.DOI:10.16139/j.1007-9610.2026.04.05
肿瘤大小辅助甲状腺髓样癌术前颈部淋巴结转移风险评估的回顾性研究:基于SEER数据库
Tumor size as a predictor for preoperative assessment of cervical lymph node metastasis in medullary thyroid car-cinoma:a retrospective study based on the SEER database
摘要
Abstract
Objective To systematically evaluate influencing factors of cervical lymph node metastasis in medullary thyroid carcinoma(MTC)patients using the SEER database,with a focus on the dose-response relationship between tumor size and lymph node metastasis,and to determine the optimal clinical cut-off value.Methods A total of 2,875 MTC patients diagnosed between 2000 and 2023 were extracted from the Surveillance,Epidemiology,and End Results(SEER)database.Univariate and multivariate logistic regression were used to identify independent predictors,with Poisson regression estimating risk ratios(RR).Restricted cubic spline(RCS)assessed the dose-response relationship,and maximally selected rank statistics(MAXSTAT)determined the optimal cut-off value.Model performance was assessed through internal validation,calibration curves,and decision curve analysis(DCA),and sensitivity analyses were conducted stratified by the extent of lymph node dissection.Results Multivariate logistic regression and sensitivity analyses showed that female sex(OR=0.40,P<0.001)and age≥75 years(OR=0.40,P<0.001)were protective factors,while tumor size was a significant independent risk factor(P<0.001).RCS revealed an approximate log-linear relationship between tumor size and lymph node metastasis risk(overall P<0.001).The optimal cut-off was diameter 12 mm;using this threshold,>12 mm group had a significantly higher metastasis rate than the≤12 mm group(52.6％vs.20.2％,OR=4.38,P<0.001).Internal validation yielded an area under the receiver operating characteristic curve(AUC)of 0.657(95％CI:0.629-0.686),with calibration curves and DCA indicating clinical net benefit.Sensitivity analyses confirmed the robustness of the tumor size effect across different dissection extent subgroups.Conclusions Tumor size is an important independent predictor of lymph node metastasis in MTC.The 12 mm threshold may serve as a candidate ancillary tool for preoperative risk stratification,prompting enhanced imaging evaluation.This threshold should be interpreted in conjunction with calcitonin levels,RET mutation status,and clinical N stage to inform treatment planning.Given the absence of these molecular and biochemical data in the SEER database,this threshold alone cannot be used as an independent criterion for determining the extent of lymph node dissection.关键词
甲状腺髓样癌/颈部淋巴结转移/肿瘤大小/监测、流行病学和最终结果(SEER)数据库Key words
Medullary thyroid carcinoma/Cervical lymph node metastasis/Tumor size/Surveillance,Epidemiology,and End Results(SEER)database分类
医药卫生引用本文复制引用
田元,刘勋..肿瘤大小辅助甲状腺髓样癌术前颈部淋巴结转移风险评估的回顾性研究:基于SEER数据库[J].外科理论与实践,2026,31(4):306-318,13.基金项目
辽宁省科技计划联合计划(自然科学基金)(2024-MSLH-583) （自然科学基金）
