摘要
目的 分析甲状腺乳头状癌(PTC)颈部中央区淋巴结转移(CLMN)的危险因素,构建预测其发生风险的列线图模型.方法 回顾性分析2021年4月至2024年3月湖北省中医院收治的100例PTC患者临床资料.根据术后病理学结果有无CLNM分为转移组(n=27)和非转移组(n=73).以多因素Logistic回归分析确定PTC患者CLNM发生的独立危险因素,并依据上述危险因素构建列线图预测模型量化PTC患者CLNM的发生概率,通过受试者操作特征(ROC)曲线验证列线图预测模型的效能.结果 转移组的男性、年龄＜45岁及v-Raf小鼠肉瘤病毒癌基因同源物B1(BRAF)突变的比例分别为37.04％、70.37％、81.48％,均高于非转移组(15.07％、42.47％、57.53％),差异均有统计学意义(P＜0.05).转移组结节直径＞10 mm、多病灶、形态不规则、有微钙化、有被膜接触及血流信号明显的比例分别为44.44％、59.26％、70.37％、74.07％、51.85％、85.19％,均高于非转移组(21.92％、26.03％、34.25％、41.10％、26.03％、53.42％),差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果表明,男性、结节直径＞10 mm、多病灶、有微钙化及有被膜接触是PTC患者发生CLNM的独立危险因素(P＜0.05).ROC曲线显示,列线图预测模型的曲线下面积为0.816(95％CI:0.726～0.886),敏感度和特异度分别为77.78％和82.19％.结论 男性、结节直径＞10 mm、多病灶、有微钙化及有被膜接触是PTC患者发生CLNM的独立危险因素,基于上述危险因素构建的列线图模型可有效评估PTC患者CLNM发生概率,辅助临床医师诊疗.
Abstract
Objective To analyze the ultrasound characteristics and clinical factors of patients with central lymph node metastasis(CLMN)in the neck of papillary carcinoma of thyroid(PTC),and to construct a nomogram prediction model to predict the probability of CLNM.Methods The clinical data of 100 PTC patients admitted to Hubei Provincial Hospital of Traditional Chinese Medicine from April 2021 to March 2024 were retrospectively analyzed.According to the postoperative pathological results,the patients were divided into the metastatic group(n=27)and the non-metastatic group(n=73).The independent risk factors of CLNM in PTC patients were determined by multivariate Logistic regres-sion analysis,and a nomogram prediction model was constructed based on the above risk factors to quantify the probability of CLNM in PTC pa-tients.The efficacy of the nomogram prediction model was verified by the receiver operating characteristic(ROC)curve.Results The proportions of male,age＜45 years old and v-raf murine sarcoma viral oncogene homolog B1(BRAF)mutation in the metastatic group were 37.04％,70.37％and 81.48％,respectively,which were higher than those in the non-metastatic group(15.07％,42.47％,57.53％),and the differences were statistically significant(P＜0.05).The proportions of nodules with diameter＞10 mm,multiple lesions,irregular shape,microcalcification,capsule contact and obvious blood flow signal in the metastatic group were 44.44％,59.26％,70.37％,74.07％,51.85％and 85.19％,re-spectively,which were higher than those in the non-metastatic group(21.92％,26.03％,34.25％,41.10％,26.03％,53.42％),and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that male,nodule diameter＞10 mm,multi-ple lesions,microcalcification and capsule contact were independent risk factors for CLNM in PTC patients(P＜0.05).The ROC curve showed that the area under the curve of the nomogram prediction model was 0.816(95％CI:0.726-0.886),and the sensitivity and specificity were 77.78％and 82.19％,respectively.Conclusion Male,nodule diameter＞10 mm,multiple lesions,microcalcification and capsule contact are independent risk factors for CLNM in PTC patients.The nomogram prediction model based on ultrasonic features and clinical factors can effectively predict CLNM in PTC patients before operation.
维普
万方数据