甲状腺癌术后复发相关危险因素分析及复发预测模型构建  

Study on risk factors of thyroid cancer recurrence and prediction model establishment

作　　者：陈志丹[1] 陈德杰[1] 

机构地区：[1]湖北省襄阳市中心医院普外一科,湖北襄阳441021

出　　处：《东南大学学报（医学版）》2015年第1期92-95,共4页Journal of Southeast University(Medical Science Edition)

摘　　要：目的：探讨甲状腺癌术后复发的相关危险因素,构建甲状腺癌复发的预测模型。方法：回顾性分析2009年6月至2012年12月手术治疗且经病理确诊的甲状腺癌患者的临床资料,并对患者的术后复发情况进行追踪随访；采用Kaplan-Meier法计算患者的术后复发率,绘制患者的无复发生存曲线；运用多因素Cox回归模型分析患者术后复发的独立危险因素,并建立复发预测模型。结果：共纳入符合条件的甲状腺癌患者376例,男86例,女290例；年龄16~81岁,平均（43.5±8.1）岁。随访1~58个月,中位随访时间24个月；随访期间97例（25.8%）患者复发,无复发生存时间1~58个月,1年、2年、3年累积无复发生存率分别为96.8%、92.5%、87.9%。多因素Cox回归模型分析发现,肿瘤最大直径≥4 cm、手术方式为单侧腺叶加峡部切除、病理类型为未分化癌、未作淋巴结清扫是甲状腺癌患者术后复发的独立危险因素（P〈0.05）。预测模型为：h（t）=h0exp（3.798 x1＋2.721 x2＋5.972 x3＋2.679 x4）。结论：肿瘤体积大、单侧腺叶加峡部切除术、病理组织学恶性程度高及未作淋巴结清扫是甲状腺癌患者术后复发的主要危险因素。Objective：To explore risk factors of thyroid cancer recurrence and establish prediction model for recurrent thyroid cancer. Methods： We retrospectively reviewed the patients diagnosed pathologically with thyroid cancer during the period from June, 2009 to December, 2012 and followed up the patients. Kaplan-Meier method was used to estimate recurrence rates and to plot relapse-free survival curves of patients at different levels of predictive factors. Multivariate Cox proportional hazards model was used to analysis inde-pendent risk factors of patients’ relapse and establish prediction model for recurrent thyroid cancer. Results：376 cases of thyroid cancer patients were included, male 86 cases, female 290 cases, age 16-81 years old, mean age （43. 5 ± 8. 1）years old, followed up 1 to 58 months, with a median follow-up time of 24 months. 97＆nbsp;cases of （25. 8%） patients relapse, relapse-free survival time from 1 to 58 months, one year, two years, three years cumulative recurrence-free survival rates were 96 . 8%, 92 . 5%, 87 . 9%. Multivariate Cox proportional hazards regression analysis found that maximum tumor diameter〉 4 cm, lobectomy plus isthmus resection, undifferentiated carcinoma, did not undergo lymph node dissection were independent risk factors for recurrence with thyroid cancer （ P 〈0 . 05 ） . The risk of recurrence in patients with thyroid cancer function model expression was：h（t） =h0exp（3. 798 x1 ＋2. 721 x2 ＋5. 972 x3 ＋2. 679 x4）. Conclusion：Tumor size, lobectomy plus isthmectomy, high degree of malignancy histopathology, and without lymph node dissection are the main risk factors for thyroid cancer recurrence.

关 键 词：甲状腺癌 复发 危险因素 COX回归模型 

分 类 号：R736.1[医药卫生—肿瘤]