Construction and verification of lymph node metastasis model of cN0 stage thyroid micropapillary carcinoma and discussion of surgical methods
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摘要: 目的 构建和验证cN0期甲状腺微小乳头状癌Ⅵ区淋巴结转移模型, 探讨甲状腺腺叶切除联合预防性Ⅵ区淋巴结清扫在cN0期甲状腺微小乳头状癌手术中的意义。方法 收集cN0期甲状腺微小乳头状癌并行Ⅵ区淋巴结清扫的患者670例。所有患者均行患侧甲状腺腺叶±峡部切除+同侧Ⅵ区淋巴结清扫。将性别、年龄、甲状腺乳头状癌的大小、是否多灶、是否被膜侵犯与中央区淋巴结是否转移构建Logistic回归模型, 并用列线图展示最终的回归模型。鉴别力和预测准确性用C指数, 校正曲线和ROC曲线评价。采用内部验证组对拟合模型进行测试。根据肿瘤最大直径分层分析淋巴结转移趋势。随访分析再次手术情况, 评估初次手术治疗效果。结果 Ⅵ区淋巴结转移率为36.7%。多元回归分析纳入3个变量, 肿瘤最大直径(P < 0.001)、男性(P < 0.001)及年轻(P < 0.001)是淋巴结转移的主要独立风险因素。结论 甲状腺腺叶切除联合预防性Ⅵ区淋巴结清扫再次手术率低, 该手术方案治疗cN0期甲状腺微小乳头状癌安全、可靠, 值得推广。Abstract: Objective To construct and verify a model of lymph node metastasis in cN0 stage thyroid micropapillary carcinoma. To explore the significance of thyroid gland lobectomy combined with prophylactic zone Ⅵ lymph node dissection in cN0 stage thyroid micropapillary carcinoma surgery.Methods The clinical data of 670 patients with cN0 stage thyroid micropapillary carcinoma and area Ⅵ lymph node dissection were collected. All patients underwent the affected thyroid gland lobe±isthmus resection+ area Ⅵ lymphadenectomy on the same side. Logistic regression model was constructed by gender, age, size of thyroid papillary carcinoma, whether it was multifocal, whether it was encroaching on the membrane, and whether the lymph nodes in the central area were metastasized, and displayed by nomogram. Discrimination and prediction accuracy were evaluated by C-index, calibration curve and ROC curve. An internal validation group was used to test the fitted model. Analyze the lymph node metastasis trend according to the largest tumor diameter. Follow-up analysis of the reoperation was conducted to evaluate the effect of initial surgery.Results The rate of lymph node metastasis in area Ⅵ was 36.7%. Multiple regression analysis included three variables. The largest tumor diameter(P < 0.001), male(P < 0.001) and young(P < 0.001) were the main independent risk factors for lymph node metastasis.Conclusion The reoperation rate of thyroid gland lobectomy combined with prophylactic zone Ⅵ lymph node dissection was low, and this surgical method might be safe and reliable for the treatment of cN0 stage thyroid micropapillary carcinoma, and it is worthy of promotion.
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Key words:
- thyroid neoplasms /
- lymph node metastasis /
- surgical procedures /
- prediction /
- nomograms
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表 1 回归模型中的变量及对应参数
参数 系数 标准误差 Wald Z P 常数 0.0665 0.5598 0.12 0.9055 肿瘤最大直径 0.2357 0.0536 4.40 < 0.0001 性别 0.9196 0.2776 3.31 0.0009 年龄 -0.0527 0.0118 -4.47 < 0.0001 
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