摘要
目的 通过列线图构建甲状腺滤泡癌危险因素模型,为甲状腺滤泡性肿瘤术前诊断提供参考.方法 收集2018年4月至2023年10月南京医科大学第一附属医院初次手术的单灶甲状腺滤泡性肿瘤196例患者的临床、超声及病理资料,为训练队列,回顾性分析其临床超声特征与甲状腺滤泡癌的关系;收集同时期南京中医药大学附属南京医院初次手术的单灶甲状腺滤泡性肿瘤患者48例的临床、超声及病理资料,为验证队列.结果 训练队列中有63例(32.1％)为甲状腺滤泡癌.单因素分析显示术前血清甲状腺球蛋白值较高[390.1(106.7～500.0)ng/ml比42.6(27.7～139.2)ng/ml,Z=-5.612,P＜0.001],超声内部结构为实性(81.0％比 54.1％,x2=13.154,P＜0.001)、内部为低回声(68.3％比 15.0％,x2=55.507,P＜0.001)、形态不规则(39.7％比3.0％,x2=45.612,P＜0.001)、边缘不光整(20.6％比 1.5％,x2=19.515,P＜0.001)、内部钙化(52.4％比 16.5％,x2=27.201,P＜0.001)、无声晕或声晕厚薄不均(85.7％比24.8％,x2=64.235,P＜0.001)、实性部分回声不均匀(74.6％比 19.5％,x2=55.437,P＜0.001)者更多病理诊断为甲状腺滤泡癌.多因素回归分析显示患者术前血清甲状腺球蛋白水平(OR=1.001,95％CI:1.000～1.002,P=0.046)、肿瘤内部结构实性(OR=4.967,95％CI:1.602～15.405,P=0.006)、伴钙化(OR=4.238,95％CI:1.550～11.588,P=0.005)、无声晕(OR=4.225,95％CI:1.353～13.192,P=0.013)、声晕厚薄不均(OR=21.240,95％CI:3.242～139.160,P=0.001)、实性部分回声不均匀(OR=4.580,95％CI:1.678～12.505,P=0.003)是甲状腺滤泡癌的独立危险因素.根据上述变量构建列线图,ROC曲线显示AUC值为0.931.结论 患者术前血清甲状腺球蛋白水平高、肿瘤内部回声实性、伴钙化、无声晕或声晕厚薄不均、实性部分回声不均匀是甲状腺滤泡癌的独立危险因素.
Abstract
Objective To construct model of risk factors for follicular thyroid carcinoma.Methods Clinical,ultrasound,and pathological data of 196 patients with single thyroid follicular neoplasm who underwent initial surgical treatment at the First Affiliated Hospital of Nanjing Medical University from Apr 2018 to Oct 2023 were collected as a training cohort.The clinical,ultrasound,and pathological data of 48 patients with the same condition at the Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine were used as a validation cohort.Results Among the training cohort,63 cases(32.1％)were diagnosed with follicular thyroid carcinoma.Univariate analysis showed that patients with higher preoperative thyroglobulin levels[390.1(106.7-500.0)ng/ml vs.42.6(27.7-139.2)ng/ml,Z=-5.612,P＜0.001],solid internal structure on ultrasound(81.0％vs.54.1％,x2=13.154,P＜0.001),low internal echogenicity(68.3％vs.15.0％,x2=55.507,P＜0.001),irregular tumor morphology(39.7％vs.3.0％,x2=45.612,P＜0.001),uneven tumor margins(20.6％vs.1.5％,x2=19.515,P＜0.001),internal tumor calcification(52.4％vs.16.5％,x2=27.201,P＜0.001),absence of acoustic halo or the acoustic halo is uneven in thickness(85.7％vs.24.8％,x2=64.235,P＜0.001),and uneven echogenicity of solid tumor portions(74.6％vs.19.5％,x2=55.437,P＜0.001)were characteristics of follicular thyroid carcinoma.Multivariate logistic analysis demonstrated that preoperative serum thyroglobulin levels(OR=1.001,95％CI:1.000-1.002,P=0.046),solid internal echogenicity of the tumor(OR=4.967,95％CI:1.602-15.405,P=0.006),tumor with calcification(OR=4.238,95％CI:1.550-11.588,P=0.005),absence of halo around the tumor(OR=4.225,95％CI:1.353-13.192,P=0.013),uneven thickness of the halo(OR=21.240,95％CI:3.242-139.160,P=0.001),and uneven echogenicity of solid tumor portions(OR=4.580,95％CI:1.678-12.505,P=0.003)were independent risk factors for follicular thyroid carcinoma.A nomogram model was constructed based on these variables,and the ROC curve showed AUC values of 0.931.Conclusion Higher preoperative serum thyroglobulin levels,solid internal echogenicity of the tumor,tumor with calcification,absence of halo around the tumor,uneven thickness of the halo,and uneven echogenicity of solid tumor portions are independent risk factors for follicular thyroid carcinoma.
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