甲状腺微小乳头状癌颈中央区淋巴结转移评分系统的初步建立  

Preliminary establishment of a scoring system for predicting cervical central lymph node metastasis in papillary thyroid microcarcinoma

作　　者：武元元[1] 王军[1] 毛爱红[2] 赵晶斌 WU Yuanyuan;WANG Jun;MAO Aihong;ZHAO Jingbin(Department of Head and Neck Surgery,Gansu Provincial Cancer Hospital,Lanzhou,Gansu,730050,China;Center for Translational Medicine,Gansu Academy of Medical Science,Lanzhou,Gansu,730050,China)

机构地区：[1]甘肃省肿瘤医院头颈外科,甘肃兰州730050 [2]甘肃省医学科学研究院转化医学中心,甘肃兰州730050

出　　处：《中国耳鼻咽喉头颈外科》2021年第11期661-663,共3页Chinese Archives of Otolaryngology-Head and Neck Surgery

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：目的初步建立预测甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)颈中央区淋巴结转移(central lymph node metastasis,CLNM)的评分系统。方法收集甘肃省肿瘤医院2013年1月~2017年12月279例临床淋巴结阴性(cN0)PTMC患者的临床资料。通过单变量和多变量分析筛选CLNM的独立风险因素并以此构建预测CLNM的"10分制"评分系统,ROC曲线分析其预测效能。结果单变量分析结果显示性别、年龄、肿瘤直径、多灶、包膜侵犯和BRAF^(V600E)突变与cN0 PTMC患者CLNM相关;多变量分析结果表明男性、年龄<45岁、肿瘤直径≥0.5 cm、多灶及包膜侵犯是CLNM的独立风险因素。评分系统预测CLNM的ROC曲线下面积为0.750(95%CI:0.568-0.932),最佳诊断界值为4分时预测的敏感性、特异性和准确率分别为71.4%、76.5%和74.2%。结论所构建的评分系统对PTMC颈部CLNM预测价值较好,评分>4分时应考虑CLNM,建议行中央区淋巴清扫术。OBJECTIVE To preliminarily establish a scoring system for predicting cervical central lymph node metastasis(CLNM)in papillary thyroid microcarcinoma(PTMC).METHODS The clinical data of 279 patients with cN0 PTMC were investigated in Gansu Provincial Cancer Hospital between January 2013 and December 2017.The univariate analysis and multiple analysis was used to select independent risk factors for CLNM,and a 10-points scoring system for predicting CLNM was constructed to evaluated its predictive value by ROC curve.RESULTS Univariateanalysis showed that gender,age,the diameter of tumor,multifocal lesions,capsular invasion and BRAF^(V600E) mutation were related to CLNM in cN0 PTMC patients.The result of multiple analysis revealed that male,age<45 years,tumor diameter≥0.5 cm,multifocal lesions and capsular invasion were independent risk factors for CLNM.The area under ROC of this scoring system was 0.750(95%CI:0.568-0.932).When 4 points was identified as the best cut-off value,the sensitivity,specificity and accuracy rate was 71.4%,76.5%and 74.2%,respectively.CONCLUSION The constructed scoring system has good predictive value of cervical CLNM in PTMC.The cN0 PTMC patients with risk score>4 points implying CLNM should be recommended to receive central lymph nodes dissection.

关 键 词：甲状腺肿瘤 淋巴转移 危险因素 甲状腺微小乳头状癌 评分系统 

分 类 号：R736.1[医药卫生—肿瘤]