甲状腺乳头状癌右侧喉返神经后方淋巴结转移的风险预测模型构建  

Construction of A Prediction Model for Lymph Node Metastasis Posterior to the Right Recurrent Laryngeal Nerve in Patients with Papillary Thyroid Carcinoma

作　　者：顾青青 王建华[1] 钱涛 章双艳 黄驰 GU Qingqing;WANG Jianhua;QIAN Tao;ZHANG Shuangyan;HUANG Chi(Afiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Traditional Chinese Medicine,Nanjing 210028,China)

机构地区：[1]南京中医药大学附属中西医结合医院,江苏南京210028

出　　处：《肿瘤学杂志》2025年第2期116-121,共6页Journal of Chinese Oncology

基　　金：江苏省卫健委课题(M2020102);江苏省中医药管理局课题(JD2023SZX03)。

摘　　要：[目的]探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)右侧喉返神经后方淋巴结转移(lymph node metastasis posterior to the right recurrent laryngeal nerve,LNM-prRLN)的危险因素,建立LNM-prRLN的列线图预测模型。[方法]回顾性分析2023年5月至2024年5月在南京中医药大学附属中西医结合医院行右侧喉返神经后方淋巴结(lymph node posterior to the right recurrent laryngeal nerve,LN-prRLN)清扫的203例PTC患者的临床病理资料,通过单因素和多因素Logistics回归分析确定LNM-prRLN的危险因素,并构建列线图预测模型,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评估模型的诊断效能,进行内部验证来验证模型的准确性。[结果]单因素分析显示,年龄≤55岁(P=0.001)、肿瘤多灶(P=0.019)、肿瘤最大径>1 cm(P<0.001)、喉前淋巴结转移(P<0.001)、右侧喉返神经前方淋巴结转移(lymph node metastasis anterior to the right recurrent laryngeal nerve,LNM-arRLN)(P=0.001)、右颈侧区淋巴结转移(P=0.009)、不合并桥本甲状腺炎(Hashimoto’s thyroiditis,HT)(P=0.007)、肿瘤突破包膜(P=0.003)、左中央区淋巴结转移(P=0.006)与LNM-prRLN显著相关。多因素分析显示,年龄≤55岁(OR=13.524,95%CI:1.577~116.001,P=0.018)、肿瘤多灶(OR=3.229,95%CI:1.323~7.878,P=0.010)、肿瘤最大径>1 cm(OR=2.527,95%CI:1.074~5.948,P=0.034)、LNM-arRLN(OR=7.706,95%CI:2.615~22.709,P<0.001)、肿瘤突破包膜(OR=4.604,95%CI:1.666~12.720,P=0.003)、不合并HT(OR=2.495,95%CI:1.057~5.892,P=0.037)是LNMprRLN的独立危险因素。基于以上危险因素构建LNM-prRLN的列线图预测模型,其ROC曲线下面积为0.851,内部验证曲线显示预测概率与实际概率之间具有良好的一致性。[结论]PTC患者年龄≤55岁、肿瘤多灶、肿瘤最大径>1 cm、存在LNM-arRLN、肿瘤突破包膜、不合并HT时,其LMNprRLN风险较大。基于以上危险因素建立的列线图预测模型具有较好的诊断效能和准确性。对于LNM-p[Objective]To investigate the risk factors for lymph node metastasis posterior to the right recurrent laryngeal nerve(LNM-prRLN)in patients with papillary thyroid carcinoma(PTC),and to establish a risk prediction model.[Methods]The clinicopathological data of 203 patients who underwent lymph node posterior to the right recurrent laryngeal nerve(LN-prRLN)clearance procedures in Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Traditional Chinese Medicine from May 2023 to May 2024 were retrospectively analyzed.The risk factors of LNMprRLN were identified by univariate and multivariate analysis.A nomogram risk prediction model based on the risk factors was developed,the performance of the model was evaluated with receiver operating characteristic(ROC)curve and the calibration curve.[Results]Univariate analysis showed that age≤55 years old(P=0.001),multifocality(P=0.019),maximum tumor diameter>1 cm(P<0.001),pre-laryngeal lymph node metastasis(P<0.001),lymph node metastasis anterior to the right recurrent laryngeal nerve(LNMarRLN)(P=0.001),right lateral cervical lymph node metastasis(P=0.009),no complicated Hashimoto's thyroiditis(HT)(P=0.007),extrathyroidal extension(P=0.003),and left central lymph node metastasis(P=0.006)were significantly associated with LNM-prRLN.Multivariate analysis showed that age≤55years old(OR=13.524,95%CI:1.577~116.001,P=0.018),multifocality(OR=3.229,95%CI:1.323~7.878,P=0.010),maximum tumor diameter>1 cm(OR=2.527,95%CI:1.074~5.948,P=0.034),LNM-arRLN(OR=7.706,95%CI:2.615~22.709,P<0.001),extrathyroidal extension(OR=4.604,95%CI:1.666~12.720,P=0.003)and no complicated HT(OR=2.495,95%CI:1.057~5.892,P=0.037)were independent risk factors for LNM-prRLN.Based on the above risk factors,a prediction nomogram model for LNM-prRLN was constructed.The area under the ROC curve was 0.851.The calibration curve showed good agreement between the predicted and observed rates of LNM-prRLN.[Conclusion]PTC patients with age≤55 years old,multifocal tumors,maximum

关 键 词：甲状腺乳头状癌 风险预测模型 喉返神经 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]