摘要
目的探讨甲状腺乳头状癌(PTC)患者右侧喉返神经深层淋巴结(LN‑prRLN)转移的相关因素,并建立评估LN‑prRLN转移的列线图模型。方法回顾性分析2020年1月至2021年12月于郑州大学第一附属医院甲状腺外科行手术治疗的PTC患者临床资料,使用多因素logistic回归分析LN‑prRLN转移的相关因素,构建列线图模型,并收集甲状腺外科2022年1至6月的120例患者资料进行外部验证。结果纳入466例PTC患者,男106例,女360例,年龄M(Q_(1),Q_(3))44(33,53)岁,训练组280例,内部验证组186例。多因素logistic回归分析结果显示,年龄(OR=0.966,95%CI:0.938~0.996,P=0.027)、肿瘤大小(OR=1.048,95%CI:1.001~1.098,P=0.043)、多灶(OR=2.459,95%CI:1.268~4.767,P=0.008)、超声报告右中央区淋巴结转移(OR=3.099,95%CI:1.255~7.651,P=0.014)、腺外侵犯(OR=3.561,95%CI:1.255~10.102,P=0.017)和血清甲状腺球蛋白水平(OR=1.010,95%CI:1.001~1.018,P=0.032)是LN‑prRLN转移的相关因素。训练组、内部验证组和外部验证组受试者工作特征(ROC)曲线的曲线下面积分别为0.765(95%CI:0.691~0.840)、0.747(95%CI:0.657~0.837)和0.754(95%CI:0.639~0.869)。结论对于肿瘤直径大、多灶、超声报告右中央区淋巴结转移、腺外侵犯及血清甲状腺球蛋白水平高的年轻PTC患者,建议行LN‑prRLN清扫。
Objective To explore the related factors of lymph nodes posterior to the right recurrent laryngeal nerve(LN‑prRLN)metastasis in papillary thyroid carcinoma(PTC)and establish a nomogram model for evaluating LN‑prRLN metastasis.Methods The clinical data of patients with PTC who underwent surgery in the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021 were retrospectively analyzed.Multivariate logistic regression was used to analyze the related factors of LN‑prRLN metastasis and construct a nomogram model for evaluating LN‑prRLN metastasis.Meanwhile,the data of 120 patients from January to June 2022 were also collected for external verification.Results A total of 466 patients with PTC were enrolled,including 106 males and 360 females,and aged 44(33,53)years.There were 280 cases in the training group and 186 cases in the internal validation group,respectively.Multivariate logistic regression analysis showed that age(OR=0.966,95%CI:0.938-0.996,P=0.027),tumor size(OR=1.048,95%CI:1.001-1.098,P=0.043),multifocality(OR=2.459,95%CI:1.268-4.767,P=0.008),right central lymph node metastasis reported by ultrasound(OR=3.099,95%CI:1.255-7.651,P=0.014),extrathyroid extension(OR=3.561,95%CI:1.255-10.102,P=0.017)and serum thyroglobulin level(OR=1.010,95%CI:1.001-1.018,P=0.032)were related factors for LN‑prRLN metastasis.The area under the curve(AUC)values of receiver operating characteristic(ROC)curves of the training group,internal validation group and external validation group were 0.765(95%CI:0.691-0.840),0.747(95%CI:0.657-0.837)and 0.754(95%CI:0.639-0.869),respectively.Conclusion Dissection of the LN‑prRLN is recommended for young PTC patients with large tumor size,multifocality,right central lymph node metastasis reported by ultrasound,extrathyroid extension and high serum thyroglobulin level.
作者
王梓洋
苌群刚
郭浩浩
杜新
刘益豪
殷德涛
Wang Ziyang;Chang Qungang;Guo Haohao;Du Xin;Liu Yihao;Yin Detao(Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第28期2175-2182,共8页
National Medical Journal of China
基金
河南省自然科学基金面上项目(222300420568)
河南省医学科技攻关重大计划项目(SBGJ202101014)
河南省中医药研究重大专项(20‑21ZYZD14)
河南省中青年医学科技创新领军人才(YXKC2020015)
关键词
甲状腺肿瘤
喉返神经
淋巴结
列线图
相关因素
Thyroid neoplasms
Recurrent laryngeal nerve
Lymph nodes
Nomograms
Related factors
