甲状腺乳头状癌右侧喉返神经后方淋巴结转移风险列线图预测模型的构建及验证  

Construction and verification of nomogram prediction model for risk of posterior lymph node metastasis of right recurrent laryngeal nerve in papillary thyroid carcinoma

作　　者：张天昊 郝志伟[1] 安杰[1] 李金 李锦行 姜战武 ZHANG Tianhao;HAO Zhiwei;AN Jie;LI Jin;LI Jinhang;JIANG Zhanwu(Second Department of General Surgery,Baoding No.1 Central Hospital,Baoding,Hebei 071000,P.R.China;Department of Obstetrics,Baoding No.1 Central Hospital,Baoding,Hebei 071000,P.R.China)

机构地区：[1]保定市第一中心医院普通外二科,河北保定071000 [2]保定市第一中心医院产科,河北保定071000

出　　处：《中国普外基础与临床杂志》2025年第2期213-218,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：河北省医学科学研究课题(项目编号:20251439);保定市科技计划项目(项目编号:2141ZF076)。

摘　　要：目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)发生右侧喉返神经后方淋巴结(lymph nodes posterior to the right recurrent laryngeal nerve,LN-prRLN)转移的影响因素,并构建临床列线图预测模型,为LN-prRLN清扫决策提供参考依据。方法通过回顾性分析保定市第一中心医院普外科2021年1月至2023年12月期间收治的PTC患者的临床资料,其中行LN-prRLN清扫325例,根据是否出现LN-prRLN转移分为非转移组(269例)和转移组(56例)。通过比较2组患者临床病理特征方面的差异,分析探讨LN-prRLN转移的危险因素,然后以危险因素构建LN-prRLN转移的列线图预测模型并验证及评估模型效能。结果共纳入325患者,其中56例(17.23%)发生LN-prRLN转移。单因素分析结果显示:性别、腺外侵犯、右侧喉返神经前方淋巴结(ymph nodes anterior to right recurrent laryngeal nerve,LN-arRLN)转移、癌灶位置和侧颈区淋巴结转移(lateral lymph node metastasis,LLNM)与PTC发生LN-prRLN转移相关(P<0.05)。多因素logistic回归分析结果显示:男性[OR=3.878,95%CI为(1.192,12.615)]、有腺外侵犯[OR=2.836,95%CI为(1.036,7.759)]、有LNarRLN转移[OR=10.406,95%CI为(3.225,33.926)]、右侧癌灶[OR=5.632,95%CI为(1.812,17.504)]和有LLNM[OR=3.426,95%CI为(1.147,10.231)]是LN-prRLN转移的危险因素。基于以上危险因素构建的列线图预测模型的受试者工作特征曲线显示:曲线下面积为0.865,95%CI为(0.795,0.934),约登指数为0.729,敏感度为0.873,特异度为0.856,具有较高的预测价值。Bootstrap检验内部验证一致性指数为0.840,95%CI为(0.755,0.954)。校正曲线显示预测值靠近理想曲线,有较好的一致性,临床决策曲线分析显示该模型对PTC发生LN-prRLN转移的临床预测效果良好。结论男性、腺外侵犯、LN-arRLN转移、右侧癌灶和LLNM是PTC发生LN-prRLN转移的危险因素,基于以上危险因素构建的列线图预测模型有较高的区分度和校准度,有助于外科医生�Objective To explore the influencing factors affecting lymph nodes posterior to the right recurrent laryngeal nerve(LN-prRLN)metastasis in papillary thyroid carcinoma(PTC)and construct a clinical nomogram prediction model to provide a reference for LN-prRLN dissection decision-making.Methods The clinical data of PTC patients admitted to the General Surgery Department of Baoding No.1 Central Hospital from January 2021 to December 2023 were retrospectively analyzed.Among them,325 patients underwent LN-prRLN dissection,and they were divided into non-metastatic group(269 cases)and metastasis group(56 cases)according to the presence or absence of LN-prRLN metastasis.By comparing the differences of clinical and pathological characteristics between the two groups,the risk factors of LN-prRLN metastasis were analyzed and discussed,and then the nomogram prediction model of LN-prRLN metastasis was constructed with the risk factors,and the effectiveness of the model was verified and evaluated.Results In 325 patients,56 cases(17.23%)occurred LN-prRLN metastasis.The results of univariate analysis showed that gender,extrathyroidal extension,lymph nodes anterior to right recurrent laryngeal nerve(LN-arRLN)metastasis,location of cancer focus,and lateral lymph node metastasis(LLNM)were related to LN-prRLN metastasis of PTC(P<0.05).Multivariate binary logistic regression analysis showed that male[OR=3.878,95%CI(1.192,12.615)],with extrathyroidal extension[OR=2.836,95%CI(1.036,7.759)],with LN-arRLN metastasis[OR=10.406,95%CI(3.225,33.926)],right cancer focus[OR=5.632,95%CI(1.812,17.504)]and with LLNM[OR=3.426,95%CI(1.147,10.231)]were the risk factors of LNprRLN metastasis.Receiver operating characteristic curves of nomogram prediction model based on the above risk factors showed that the area under the curve was 0.865,95%CI was(0.795,0.934),Jordan index was 0.729,sensitivity was 0.873,and specificity was 0.856,which had higher prediction value.The C-index of Bootstrap test was 0.840[95%CI(0.755,0.954)].Calibration curves showed tha

关 键 词：甲状腺乳头状癌 右侧喉返神经后方淋巴结 淋巴结转移 危险因素 预测模型 

分 类 号：R736.1[医药卫生—肿瘤]