Analysis of Risk Factors for Postoperative Recurrent Laryngeal Nerve Injury in Patients with Thyroid Cancer and Construction of Related Prediction Models
Objective To investigate the risk factors of recurrent laryngeal nerve(RLN)injury in patients with thyroid cancer after surgery,and to construct a relevant prediction model.Methods A total of 380 patients with thyroid cancer who were admitted to the People's Hospital of Guangxi Zhuang Autonomous Region from January 2019 to January 2023 were included in the study.According to whether RLN injury occurred aftersurgery,they were divided into RLN injury group(n=23)and N-RLN injury group(n=357).The general clinical data and operation-related data of the two groups were compared.Multivariate Logistic regression analysis was used to obtain independent predictors of RLN injury in patients with thyroid cancer after operation.Based on independent predictors,a nomogram model for predicting RLN injury in patients with thyroid cancer after operation was established.Bootstrap method and calibration curve were used to verify the nomogram model.The ROC curve for predicting RLN injury in patients with thyroid cancer after operation was drawn,and the predictive efficacy of independent predictors was analyzed.Results Multivariate Logistic regression analysis showed that tumor location,number of operations and intraoperative nerve monitoring were independent predictors of RLN injury in patients with thyroid cancer after surgery(P＜0.05).Based on the results of multivariate analysis,three independent predictors were obtained,namely tumor location,number of operations and intraoperative nerve monitoring,and a nomogram model was constructed to predict RLN injury in patients with thyroid cancer after operation.The discrimination evaluation index C index(C-Index)of the nomogram model was 0.869(95％CI:0.823-0.958).The goodness of fit(H-L)test results showed that the predicted value of RLN injury probability in patients with thyroid cancer after operation was in good agreement with the actual observed value(P＞0.05).The results of ROC analysis showed that the area under the curve(AUC)of tumor location,number of operations and intraoperative nerve monitoring for predicting the probability of RLN injury in patients with thyroid cancer were 0.779(95％CI:0.712-0.834),0.756(95％CI:0.709-0.816)and 0.887(95％CI:0.835-0.935),respectively.The AUC of the combined prediction of the three was 0.937(95％CI:0.887-0.976).Conclusion Tumor location,number of operations and intraoperative nerve monitoring are independent predictors of RLN injury in patients with thyroid cancer after surgery.The nomogram model based on independent predictors has a high predictive value for predicting recurrent laryngeal nerve injury in patients with thyroid cancer after surgery.
ThyroidcancerRecurrent laryngeal nerveIntraoperative nerve monitoringPrediction model
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