单发含钙化甲状腺乳头状癌射频消融术疗效评估及预测模型构建  

Efficacy Evaluation and Prediction Model Construction of Radiofrequency Ablation for Single Papillary Thyroid Carcinoma with Calcification

作　　者：李伊铭 阎琳 李欣洋 张明博 罗渝昆 LI Yiming;YAN Lin;LI Xinyang(Department of Ultrasound,The First Medical Center of Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院第一医学中心超声诊断科,北京100076

出　　处：《医学研究杂志》2025年第3期62-67,84,共7页Journal of Medical Research

基　　金：国家卫生健康委员会能力建设和继续教育中心项目(GWJJ2023100301);北京市科技计划项目(Z221100003522001)。

摘　　要：目的探讨单发含钙化甲状腺乳头状癌(papillary thyroid carcinoma,PTC)超声引导下射频消融(radiofrequency ablation,RFA)的有效性、安全性及消融灶转归。方法回顾性分析2015年1月1日~2019年12月31日行RFA手术的163例单发含钙化PTC患者。2016年12月31日前行RFA手术的患者纳入训练集,2017年1月1日后行RFA手术的患者纳入测试集。以RFA术后末次随访消融灶未消失为终点事件,通过Logistic回归分析筛选出消融灶未消失的独立危险因素,构建列线图模型,评估预测效能及临床价值;同时评估单发含钙化PTC患者RFA术后安全性及有效性。结果多因素Logistic回归分析结果显示,年龄(P=0.001)、病灶最大径(P=0.021)及钙化占比(P=0.048)是消融灶未消失的独立危险因素,建立列线图模型。该模型中训练集的曲线下面积(area under the area,AUC)为0.780,测试集的AUC为0.711。校准曲线分析显示,列线图模型预测消融灶转归情况与真实情况一致性较好,临床决策曲线具有良好的临床潜能。在163个病灶中,90个(55.2%)消融灶因结节内钙化含量较少可达到完全消失,未见严重并发症,且消融灶体积不断缩小,8例(4.9%)患者出现转移复发。结论RFA治疗单发含钙化PTC具有良好的安全性及有效性。基于年龄、肿瘤最大径、钙化占比构建的单发含钙化PTC患者RFA术后消融灶转归的预测模型具有良好的区分度和校准度,可用于评估单发含钙化PTC患者RFA术后疗效。Objective To investigate the efficacy,safety and prognosis of ultrasound-guided radiofrequency ablation(RA)for single papillary thyroid carcinoma(PTC)with calcification.Methods A retrospective analysis was performed on 163 patients with calcified single PTC who received RFA treatment from January 1,2015 to December 31,2019.The patients who underwent RFA surgery before December 31,2016 were included in the training set,the others after January 1,2017 were included in the test set.With the non-disappearance of ablation at the last follow-up after RFA as the end event,the independent risk factors for non-disappearance of ablation were screened out by Logistic regression analysis,and a nomogram was constructed to evaluate the predictive efficacy and clinical value.The safety and efficacy of RFA in patients with calcified PTC were also evaluated.Results Multivariate Logistic regression analysis showed that age(P=0.001),maximum lesion diameter(P=0.021)and calcification ratio(P=0.048)were independent risk factors for non-disappearance of ablation.A nomogram model was established,the area under the area(AUC)of this model was 0.780 in the training set,and 0.711 in the test set.The calibration curve showed that the nomogram model predicted the outcome of the ablation site in good agreement with the real situation.Cinical decision analysis curve indicated a good clinical potential.In 163 lesions,there were 90 lesions(55.2%)which with less calcification content in the nodules disappeared completely,no serious complications were observed,and the volume of ablation sites was continuously reduced,8 patients(4.9%)developed metastasis and recurred.Conclusion RFA has good safety and efficacy in the treatment of calcified PTC.The predictive model of the outcome of ablation lesion after RFA in patients with calcified single PTC constructed on the basis of age,maximum lesion diameter,and calcification ratio has good differentiation and calibration,which can be used to assess the postoperative efficacy of RFA after RFA in patients wit

关 键 词：射频消融 甲状腺乳头状癌 钙化 

分 类 号：R581[医药卫生—内分泌]