摘要
目的:构建完全腔镜下甲状腺癌根治术后甲状腺乳头状癌(PTC)患者复发的超声预测模型。方法:收集2017年2月至2020年3月我院初次行完全腔镜下甲状腺癌根治术的PTC患者264例,根据术后是否复发分为复发组和无复发组。比较两组患者临床资料及结节直径、结节数目、内部回声、微钙化等超声资料。使用单因素、Lasso及Logistic回归模型分析PTC患者术后复发的影响因素,并基于筛选的指标建立列线图模型。结果:与无复发组比较,复发组患者结节直径更大,结节边缘不规则、纵横比>1、微钙化、被膜侵犯比例更高(P<0.05)。结节直径>10 mm、边缘不规则、纵横比>1、微钙化、被膜侵犯是PTC患者术后复发的独立危险因素(P<0.05),所构建的列线图模型C-index计算结果为0.756(95%CI:0.684~0.830),ROC曲线AUC为0.895(95%CI:0.866~0.915),区分度较高;校准曲线结果显示平均偏离量为0.027,预测概率较好拟合实际概率;临床决策曲线远离极端曲线,具有良好的临床适用性。结论:基于结节大小、边缘不规则、微钙化、纵横比>1、被膜侵犯所构建的列线图模型预测PTC完全腔镜下甲状腺癌根治术后复发的准确性良好,具有一定的临床意义。
Objective:To establish an ultrasound prediction model of postoperative recurrence in patients with papillary thyroid carcinoma(PTC)after complete endoscopic radical surgery.Meth ods:264 patients with PTC who underwent complete endoscopic radical surgery for the first time in our hospital from February 2017 to March 2020 were retrospectively collected.They were divided into recurrence group and non recurrence group according to whether there was recurrence after surgery.The clinical data,nodule diameter,nodule number,internal echo,microcalcification and other ultrasonic data of the two groups were compared.Single factor,Lasso and Logistic regression models were used to analyze the influencing factors of postoperative recurrence of PTC patients,and an nomogram model was established based on the selected indicators.Results:Compared with the non recurrence group,the patients in the recurrence group had larger nodule diameter,irregular nodule edge,aspect ratio>1,microcalcification and capsule invasion(P<0.05).Nodular diameter>10 mm,irregular edge,aspect ratio>1,microcalcification and capsule invasion were independent risk factors for postoperative recurrence of PTC patients(P<0.05).The C-index of the constructed nomogram model was 0.756(95%CI:0.684~0.830),and the AUC of the ROC curve was 0.895(95%CI:0.866~0.915);The calibration curve results show that the average deviation is 0.027,and the prediction probability fits the actual probability well;The clinical decision curve is far away from the extreme curve and has good clinical applicability.Conclusion:The nomogram model based on nodule size,irregular margin,microcalcification,aspect ratio>1,and capsule invasion has good accuracy in predicting the recurrence of PTC patients after complete endoscopic radical surgery,and has certain clinical significance.
作者
陈海兰
黄建新
陈薇
CHEN Hai-lan;HUANG Jian-xin;CHEN Wei(Department of Ultrasound,Affiliated Hospital of Putian University,Putian 351100,China)
出处
《中国现代普通外科进展》
CAS
2024年第2期129-133,共5页
Chinese Journal of Current Advances in General Surgery
关键词
甲状腺乳头状癌
高分辨率超声
腔镜下根治术
预测模型
Papillary thyroid carcinoma
High resolution ultrasound
Endoscopic radical operation
Forecast model
