55岁及以上甲状腺乳头状癌淋巴结转移危险因素分析及预测模型构建OA
Analysis of risk factors and construction of prediction model for lymph node metastasis in patients with papillary thyroid carcinoma aged≥55 years
目的 分析≥55岁甲状腺乳头状癌(PTC)患者淋巴结转移(lymph node metastasis,LNM)的相关因素,并基于甲状腺自身抗体、成纤维细胞生长因子19(fibroblast growth factor 19,FGF19)和生长分化因子15(growth differentiation factor 15,GDF15)构建预测模型.方法 回顾性纳入2021年11月～2023年12月在武汉市红十字会医院接受手术治疗的≥55岁PTC患者385例,根据术后病理结果分为LNM组114例和无LNM组271例.比较两组临床病理特征、甲状腺自身抗体、甲状腺功能及FGF19、GDF15水平,采用多因素Logistic回归筛选独立相关因素并建立预测模型,绘制受试者工作特征(ROC)曲线评价模型效能.结果 385例患者中114例发生LNM,发生率为29.61%.多因素分析结果显示,肿瘤最大直径≥1.5 cm、肿瘤位于甲状腺上极或峡部、病灶多发、包膜侵犯、低分化、TgAb≥500 U/ml、FGF19≥150 pg/ml及GDF15≥500 ng/L与LNM独立相关(P均<0.05).预测模型为:logit(P)=-4.352+0.693×肿瘤最大直径≥1.5 cm+0.825×肿瘤位于甲状腺上极或峡部+0.735×病灶多发+0.806×包膜侵犯+0.703×低分化+0.783×TgAb≥500 U/ml+0.781×FGF19≥150 pg/ml+0.679×GDF15≥500 ng/L.模型AUC为0.890(95%CI:0.856～0.924),当预测概率P>0.372时,敏感度为82.5%,特异度为81.2%.颈侧区LNM亚组分析显示,淋巴结短径≥5 mm、边界不清、血流信号丰富及囊性变或钙化与转移有关.结论 肿瘤特征、TgAb、FGF19及GDF15与≥55岁PTC患者LNM密切相关,联合模型具有较好的辅助预测价值,可用于术前风险分层,但仍需多中心外部验证.
OBJECTIVE To identify factors associated with lymph node metastasis(LNM)in patients aged 55 years or older with papillary thyroid carcinoma(PTC)and to develop a prediction model incorporating thyroid autoantibodies,fibroblast growth factor 19(FGF19),and growth differentiation factor 15(GDF15).METHODS This retrospective study included 385 patients aged 55 years or older who underwent surgery for PTC at Wuhan Red Cross Hospital between November 2021 and December 2023.According to postoperative pathological findings,114 patients were assigned to the LNM group and 271 to the non-LNM group.Clinicopathological characteristics,thyroid autoantibodies,thyroid function indices,and serum FGF19 and GDF15 levels were compared.Multivariable logistic regression was used to identify independent factors and construct a prediction model,and receiver operating characteristic(ROC)analysis was performed to assess discrimination.RESULTS LNM occurred in 114 of 385 patients(29.61%).Tumor diameter≥1.5 cm,tumor location in the upper pole or isthmus,multifocality,capsular invasion,poor differentiation,TgAb≥500 U/ml,FGF19≥150 pg/ml,and GDF15≥500 ng/L were independently associated with LNM(all P<0.05).The model was:logit(P)=-4.352+0.693×tumor diameter≥1.5 cm+0.825×upper-pole or isthmus location+0.735×multifocality+0.806×capsular invasion+0.703×poor differentiation+0.783×TgAb≥500 U/ml+0.781×FGF19≥150 pg/ml+0.679×GDF15≥500 ng/L.The area under the ROC curve was 0.890(95%CI:0.856-0.924).At a predicted probability cutoff of 0.372,sensitivity was 82.5%and specificity was 81.2%.In the lateral cervical LNM subgroup,a lymph-node short-axis diameter≥5 mm,an indistinct margin,abundant vascularity,and cystic change or calcification were associated with metastasis.CONCLUSION Clinicopathological features and serum TgAb,FGF19,and GDF15 levels were associated with LNM in patients aged 55 years or older with PTC.The combined model showed good discriminatory ability for clinical risk stratification,but external multicenter validation is required.
周戌;肖敏;李三荣
武汉市红十字会医院甲乳外科,湖北 武汉 430015武汉市红十字会医院甲乳外科,湖北 武汉 430015武汉市红十字会医院甲乳外科,湖北 武汉 430015
甲状腺肿瘤乳头状甲状腺癌淋巴结转移甲状腺自身抗体成纤维细胞生长因子19生长分化因子15预测模型
Thyroid NeoplasmsThyroid Cancer,Papillarylymph node metastasisthyroid autoantibodiesfibroblast growth factor 19growth differentiation factor 15prediction model
《中国耳鼻咽喉头颈外科》 2026 (6)
307-310,4
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