甲状腺癌术后迁延性甲状旁腺功能减退风险的列线图预测模型研究  

A nomogram for predicting postoperative protracted hypoparathyroidism in patients with thyroid cancer

作　　者：徐国栋 凌煜玮 朱江[2] 张俐娜 康骅[1] XU Guodong;LING Yuwei;ZHU Jiang;ZHANG Lina;KANG Hua(Center for Thyroid and Breast Surgery,Department of General Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,P.R.China;Department of General Surgery,Beijing Pinggu Hospital,Beijing 101200,P.R.China)

机构地区：[1]首都医科大学宣武医院甲状腺乳腺疾病诊疗中心/普外科,北京100053 [2]北京市平谷区医院普通外科,北京101200

出　　处：《中国普外基础与临床杂志》2022年第1期24-31,共8页Chinese Journal of Bases and Clinics In General Surgery

基　　金：北京卫生系统高层次卫生技术人才学科带头人培养项目(项目编号:2011-2-28)。

摘　　要：目的探究甲状腺癌患者术后迁延性甲状旁腺功能(简称"甲旁功")减退的预测因素并构建列线图预测模型,以指导临床早期干预。方法回顾性分析2019年1月至2020年12月期间首都医科大学宣武医院及北京市平谷区医院收治且接受手术治疗的甲状腺癌患者的临床病理资料,采用logistic回归和LASSO回归模型分析甲状腺癌术后发生甲旁功减退的影响因素及迁延性甲旁功减退的预测因素。在训练集中构建预测术后迁延性甲旁功减退的列线图模型,然后分别在训练集和验证集中验证列线图模型的区分度与一致性。结果根据本研究的纳入和排除标准,共有464例甲状腺癌患者最终被纳入研究,其中甲旁功正常患者364例,甲旁功减退患者100例,在这100例甲旁功减退患者中短期甲旁功减退患者62例、迁延性甲旁功减退患者37例(其中1例数据不全)。logistic多因素回归分析结果发现,术前全段甲状旁腺素(iPTH)水平高是术后甲旁功减退的保护性因素[OR=0.953,95%CI(0.931,0.976),P<0.001],而单侧腺叶+对侧部分切除[OR=3.247,95%CI(1.112,9.485),P=0.031]和甲状腺全切除[OR=11.096,95%CI(5.432,22.664),P<0.001]是其危险因素。将LASSO回归模型筛选出的因素进行logistic回归多因素分析结果显示,术后第1天iPTH水平是迁延性甲旁功减退的预测因素[OR=0.719,95%CI(0.588,0.879),P=0.001],其预测迁延性甲旁功减退的受试者操作特征曲线下面积(AUC)值为0.848 [95%CI(0.755,0.942)],最佳截断值为9.405 ng/L,预测的特异度和敏感度分别为0.659、0.944,且其联合与临床有密切关系的临床病理特征腺外侵犯、累计肿瘤最大径和中央区淋巴结清扫构建的列线图预测模型预测迁延性甲旁功减退的AUC值为0.900 [95%CI(0.817,0.982)],最佳截断值为118.891分,预测的特异度和敏感度分别为0.772、0.944;Hosmer-Lemeshow拟合优度检验结果证实模型拟合度良好(χ^(2)=8.605,P=0.377)。在验证集(�Objective To discover the indicators and develop a model for predicting protracted hypoparathyroidism(HPT) after thyroid cancer surgery in order to guide the early therapy for patients with HPT. Methods The clinical and postoperative pathological data of patients with thyroid cancer who received surgical treatment in the Xuanwu Hospital and Beijing Pinggu Hospital from January 2019 to December 2020 were retrospectively analyzed. The potential indicators of postoperative HPT and protracted HPT were analyzed by logistic and LASSO regression analysis.A nomogram for predicting protracted HPT was constructed in the training set, and the discrimination and consistency of the nomogram were verified in the training set and the validation set respectively. Results According to the inclusion and exclusion criteria, a total of 464 patients diagnosed with thyroid cancer were finally included in the study. Among the100 patients with postoperative HPT(except 1 case of incomplete data), 62 patients showed short-term HPT and 37 patients developed protracted HPT. Multivariate logistic regression analysis showed that the preoperative intact parathyroid hormone(iPTH) level [OR=0.953, 95%CI(0.931, 0.976), P<0.001], lobectomy with contralateral partial lobectomy [OR=3.247, 95%CI(1.112, 9.485), P=0.031], and total thyroidectomy [OR=11.096, 95%CI(5.432, 22.664),P<0.001] were related to postoperative HPT. The multivariant logistic regression analysis revealed that postoperative iPTH level was a predictive factor for protracted HPT [OR=0.719, 95%CI(0.588, 0.879), P=0.001]. The area under receiver operating characteristic curve(AUC) value of postoperative iPTH level in predicting protracted HPT was 0.848[95%CI(0.755, 0.942)];The cut-off value was 9.405 ng/L, and its specificity and sensitivity were 0.659 and 0.944,respectively. Moreover, the AUC value of the nomogram model including postoperative iPTH level and other clinicopathologic features(extraglandular invasion, cumulative maximum tumor diameter, and central lymph node dissection) f

关 键 词：甲状腺癌 手术 迁延性甲状旁腺功能减退 列线图 全段甲状旁腺素 

分 类 号：R736.1[医药卫生—肿瘤]