DTC远处转移的危险因素分析及列线图预测模型的建立  

Analysis of the risk factors for distant metastasis of differentiated thyroid cancer and establishment of a nomogram prediction model

作　　者：刘欢 晋建华[1] Liu Huan;Jin Jianhua(Department of Nuclear Medicine,the First Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第一医院核医学科,太原030001

出　　处：《国际放射医学核医学杂志》2024年第5期285-293,共9页International Journal of Radiation Medicine and Nuclear Medicine

摘　　要：目的探讨分化型甲状腺癌(DTC)患者发生远处转移的危险因素,构建远处转移的列线图预测模型并评估其预测价值。方法回顾性分析2018年12月至2021年12月山西医科大学第一医院收治的655例DTC患者的临床及组织病理学检查结果等资料,其中男性221例、女性434例,年龄(44.4±11.5)岁,范围10~77岁。通过单因素分析确定DTC患者远处转移的危险因素,采用受试者工作特征(ROC)曲线确定最佳临界值。通过多因素Logistic回归分析确定DTC患者远处转移的独立危险因素,并构建远处转移的列线图预测模型。通过ROC曲线、校准曲线和临床决策曲线分析(DCA)评估模型的区分度、校准度和临床净收益。结果单因素分析结果显示,性别、年龄、病理类型、肿瘤最大径、脉管癌栓、包膜或甲状腺外侵犯、颈侧区淋巴结转移、颈侧区合并中央区淋巴结转移、转移淋巴结数量、首次131I治疗距离手术时间、131I治疗前刺激性甲状腺球蛋白(sTg)水平为DTC发生远处转移的危险因素(χ^(2)=4.150~215.570,均P<0.05)。年龄、肿瘤最大径、转移淋巴结数量、首次131I治疗距离手术时间、131I治疗前sTg水平预测远处转移的最佳临界值分别为55岁[曲线下面积(AUC)为0.548,95%CI:0.452~0.643]、2 cm(AUC为0.740,95%CI:0.663~0.818)、6个(AUC为0.684,95%CI:0.605~0.764)、3个月(AUC为0.625,95%CI:0.548~0.702)、19.43 ng/ml(AUC为0.927,95%CI:0.886~0.967)。多因素Logistic回归分析结果表明,年龄≥55岁、肿瘤最大径≥2 cm、转移淋巴结数量≥6个以及131I治疗前sTg水平≥19.43 ng/ml是DTC发生远处转移的独立危险因素(OR=3.427~34.239,均P<0.05)。构建的列线图预测模型具有较好的预测效能,即良好的区分度(AUC为0.920,95%CI:0.877~0.963,P<0.05)和校准度(平均绝对误差=0.007)。临床DCA结果表明,模型的临床净收益较好。结论年龄≥55岁、肿瘤最大径≥2 cm、转移淋巴结数量≥6个以及131I治疗前sTg�Objective To investigate the risk factors for distant metastasis in patients with differentiated thyroid cancer(DTC),construct a nomogram prediction model for distant metastasis,and assess its predictive value.Methods The clinical and histopathological examination data of 655 patients with DTC admitted to the First Hospital of Shanxi Medical University from December 2018 to December 2021 were retrospectively analyzed.The patients included 221 males and 434 females aged(44.4±11.5)years with an age range of 10–77 years.The risk factors for distant metastasis in patients with DTC were determined through univariate analysis,and their optimal cut-off values were established through receiver operating characteristic(ROC)curve analysis.Multivariate Logistic regression analysis was employed to identify independent risk factors for distant metastasis in patients with DTC,and a nomogram prediction model was developed.The discrimination ability,calibration,and clinical net benefit of the model were assessed on the basis of ROC curves,calibration curves,and clinical decision curve analysis(DCA).Results Univariate analysis indicated that gender,age,pathological type,maximum tumor diameter,vascular tumor thrombus,capsule or extrathyroidal extension,lateral cervical lymph node metastasis,lateral cervical lymph node metastasis combined with central lymph node metastasis,metastatic lymph node number,the interval between the first 131I treatment and operation,and stimulated thyroglobulin(sTg)level before 131I treatment were risk factors for the distant metastasis of DTC(χ^(2)=4.150–215.57,all P<0.05).The optimal cut-off values for age,maximum tumor diameter,metastatic lymph node number,the interval between the first 131I treatment and operation,and sTg level before 131I treatment for predicting distant metastasis were 55 years old(area under the curve(AUC)=0.548,95%CI:0.452–0.643),2 cm(AUC=0.740,95%CI:0.663–0.818),6(AUC=0.684,95%CI:0.605–0.764),3 months(AUC=0.625,95%CI:0.548–0.702),and 19.43 ng/ml(AUC=0.927,95%CI:0.8

关 键 词：分化型甲状腺癌 远处转移 危险因素 列线图 预测模型 

分 类 号：R736.1[医药卫生—肿瘤]