A nomograph model for prediction of central lymph node metastasis of papillary thyroid carcinoma
GAO Mengyang1, LOU Pengwei2, MA Li2, LI Hui2, HUANG Yuting2, WANG Lu1, WANG Kai3
1. School of Public Health, Xinjiang Medical University, Urumqi, Xinjiang 830011, China; 2. Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830002, China; 3. Xinjiang Medical University, Urumqi, Xinjiang 830011, China
Abstract：Objective To establish a nomograph model for prediction of cervical central lymph node metastasis (CLNM) among patients with thyroid papillary carcinoma (PTC), so as to provide the evidence for designing personalized treatment plans for PTC. Methods The data of patients that underwent thyroidectomy and were pathologically diagnosed with PTC post-surgery in the Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University from 2018 to 2021 were collected. Patients' data captured from 2018 to 2020 and from 2021 were used as the training set and the validation set, respectively. Predictive factors were screened using a multivariable logistic regression model, and the nomograph model for prediction of CLNM risk was established. The predictive value of the model was evaluated using the receiver operating characteristic (ROC) curve and the adjusted curve. Results Totally 1 820 PTC cases were included in the training set, including 458 cases with CLNM (25.16%), and 797 cases in the validation set, including 207 cases with CLNM (25.98%). The prediction model is p=ey/(1+ey), y=0.761 + 0.525 × sex + (-0.039) ×age + 0.351 × extrathyroid invasion + 0.368 × neck lymph node enlargement + 1.021×maximum tumor diameter + (-0.009) × TT4 + (-0.001) × anti-TPOAb. The area under the ROC curve was 0.732 for the training set and 0.731 for the validation set, and Hosmer-Lemeshow test showed a good fitting effect (P=0.936, 0.722). Conclusion The nomograph model constructed in this study has a high predictive value for CLNM among patients with PTC.
高梦阳, 娄鹏威, 马丽, 李惠, 黄玉婷, 王璐, 王凯. 甲状腺乳头状癌中央区淋巴结转移预测模型研究[J]. 预防医学, 2023, 35(3): 229-234.
GAO Mengyang, LOU Pengwei, MA Li, LI Hui, HUANG Yuting, WANG Lu, WANG Kai. A nomograph model for prediction of central lymph node metastasis of papillary thyroid carcinoma. Preventive Medicine, 2023, 35(3): 229-234.
[1] FERLAY J,COLOMBET M,SOERJOMATARAM I,et al.Estimating the global cancer incidence and mortality in 2018:GLOBOCAN sources and methods[J].Int J Cancer,2019,144(8):1941-1953. [2] KEBEBEW E,CLARK O H.Differentiated thyroid cancer:"complete" rational approach[J].World J Surg,2000,24(8):942-951. [3] 张俐娜,凌煜玮,李开富,等.基于SEER数据库构建的甲状腺微小乳头状癌颈淋巴结转移预测模型的术前应用价值[J].中国普外基础与临床杂志,2022,29(2):188-195. [4] 许思哲,贺功建,曾黎,等.超声联合肿瘤标记物对cN0期甲状腺微小乳头状癌中央区淋巴结隐匿性转移的预测价值[J].中华普外科手术学杂志(电子版),2021,15(3):314-318. [5] YAN Y,WANG Y,LIU N,et al.Predictive value of the Delphian lymph node in cervical lymph node metastasis of papillary thyroid carcinoma[J].Eur J Surg Oncol,2021,47(7):1727-1733. [6] CARVALHO G M C,LEITE T T,LIBORIO A B.Prediction of 60-day case fatality in critically ill patients receiving renal replacement therapy:external validation of a prediction model[J].Shock,2018,50(2):156-161. [7] 高明. 甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272. [8] 汤靖岚,侯春杰,范小明.甲状腺微小乳头状癌中央区淋巴结转移的术前超声预测模型建立[J].中华医学超声杂志(电子版),2019,16(4):257-263. [9] FENG Y,MIN Y,CHEN H,et al.Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma[J].J Endocrinol Invest,2021,44(10):2203-2211. [10] SHUAI Y J,YUE K,DUAN Y S,et al.Surgical extent of central lymph node dissection for papillary thyroid carcinoma located in the isthmus:a propensity scoring matched study[J/OL].Front Endocrinol,2021,12[2023-01-13].https://doi.org/10.3389/fendo.2021.620147. [11] LI Y,PIAO J,LI M.Secular trends in the epidemiologic patterns of thyroid cancer in China over three decades:an updated systematic analysis of global burden of disease study 2019 data[J/OL].Front Endocrinol,2021,12[2023-01-13].https://doi.org/10.3389/fendo.2021.707233. [12] YAO R,CHIU C G,STRUGNELL S S,et al.Gender differences in thyroid cancer:a critical review[J].Expert Rev Endocrinol Metab,2011,6(2):215-243. [13] ZHANG X S,ZHANG X,LIU M L,et al.Global,regional,and national burden of cirrhosis and other chronic liver diseases due to alcohol use,1990-2019:a systematic analysis for the Global Burden of Disease Study 2019[J/OL].BMC Gastroenterol,2022,22[2023-01-13].https://doi.org/10.1186/s12876-022-02518-0. [14] XIANG D,XIE L,XU Y,et al.Papillary thyroid microcarcinomas located at the middle part of the middle third of the thyroid gland correlates with the presence of neck metastasis[J].Surgery,2015,157(3):526-533. [15] 孙庆贺,李小毅,商中华.甲状腺微小乳头状癌淋巴结转移危险因素的研究进展[J].癌症进展,2016,14(1):46-49,55. [16] LEE H S,PARK C,KIM S W,et al.Correlation of minimal extrathyroidal extension with pathologic features of lymph node metastasis in patients with papillary thyroid carcinoma[J].J Surg Oncol,2015,112(6):592-596. [17] MOHAMED H E,MOHAMED S E,ANWAR M A,et al.The significance of enlarged cervical lymph nodes in diagnosing thyroid cancer[J].J Cancer Res Ther,2016,12(2):1006-1009. [18] 孙俪支,凌丰宇,郑泰浩,等.超声弹性成像联合血清TSH、TT3、TT4在甲状腺结节良恶性诊断的临床价值研究[J].现代生物医学进展,2021,21(5):941-944. [19] 胡晓萌,乔宇,韩朵兰,等.甲状腺乳头状癌颈部淋巴结转移的危险因素[J].中国肿瘤临床,2019,46(11):557-561.
