甲状腺乳头状癌中央区淋巴结转移评分系统的建立及验证  

Establishment and verification of a scoring system for predicting central lymph node metastasis in papillary thyroid carcinoma

作　　者：武元元[1] 王军[1] 毛爱红[2] 范向达[1] 张建伟[1] 段颖[3] WU Yuanyuan;WANG Jun;MAO Aihong;FAN Xiangda;ZHANG Jianwei;DUAN Ying(Department of Head and Neck Surgery,Gansu Province Cancer Hospital;Gansu Academy of Medical Science;Department of Ultrasound,Gansu Province Cancer Hospital,Lanzhou 730050,China)

机构地区：[1]甘肃省肿瘤医院头颈外科,兰州730050 [2]甘肃省医学科学研究院 [3]甘肃省肿瘤医院超声科

出　　处：《中国癌症防治杂志》2019年第6期498-502,共5页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：甘肃省卫生行业科研计划项目（GSWSKY2018-05）;陇原青年创新创业人才项目（甘组通字[2019]39号）

摘　　要：目的构建甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中央区淋巴结转移(central lymph node metastasis,CLNM)的评分系统,并评价和验证其工作效能。方法选取2015年6月-2018年6月在甘肃省肿瘤医院行手术治疗的237例PTC患者为建模组,2018年7月-2019年6月符合相同条件的100例PTC患者为验证组。采用Logistic回归模型筛选CLNM的独立危险因素并构建评分系统,ROC曲线评估预测价值。结果男性、肿瘤直径>1 cm、多发癌灶、肿瘤位于腺体下极和包膜侵犯是预测PTC CLNM的独立危险因素(P<0.05)。建模组ROC曲线下面积为0.857,最佳诊断截点值为6分,诊断敏感性、特异性、阳性预测值和阴性预测值分别为81.9%、85.3%、78.6%和87.8%,验证组ROC曲线下面积为0.823。结论基于独立危险因素的评分系统对PTC患者CLNM有较好的预测价值,评分≥6分的患者CLNM发生风险较高,应积极行预防性中央区淋巴结清扫。Objective To establish a scoring system for predicting central lymph node metastasis(CLNM)in papillary thyroid carcinoma(PTC),then evaluated and verified its work efficiency. Methods Totals of 237 patients with PTC who underwent surgery in Gansu Province Cancer Hospital from June 2015 to June 2018 were selected as the modeling group,and 100 patients met the same criteria from July 2018 to June 2019 were selected as the verification group. Logistic regression model was used to screen independent risk factors and establish scoring system for predicting CLNM,and ROC curve was used to evaluate the predictive value of the scoring system.Results Male,tumor diameter>1 cm,multifocality,lower location,and capsular invasion were independent predictive factors for CLNM.The area under ROC curve of the scoring system in modeling group was 0.857,and the best cutoff value for the diagnosis of CLNM was 6 points with sensitivity of 81.9%,specificity of 85.3%,positive predictive value of 78.6% and negative predictive value of 87.8%. The area under ROC curve of the verification group was 0.823. Conclusions The scoring system base on independent risk factors has good predictive value of CLNM in PTC. Prophylactic central neck dissection should be actively performed when the PTC patients with score ≥6 points have a high risk of CLNM.

关 键 词：甲状腺乳头状癌 中央区淋巴结转移 预防性中央区淋巴结清扫 危险因素 评分系统 

分 类 号：R736.1[医药卫生—肿瘤]