甲状腺髓样癌颈部淋巴结转移的预测模型

目的:构建甲状腺髓样癌(medullary thyroid carcinoma,MTC)颈部淋巴结转移情况的临床预测模型,个体化预测术前淋巴结转移概率.方法:回顾性筛选美国国立癌症研究所"监测、流行病学和结果"数据库(Surveillance,Epidemiology,and End Results,SEER)中的20...

Nomograms for prediction of cervical lymph node metastasis in medullary thyroid carcinoma

Objective:Establishing an appropriate clinical prediction model of lymph node metastasis may provide an individualized treatment to individually predict the probability of lymph node metastasis before surgery.Methods:739 patients with medullary thyroid carcinoma were recruited in the American cancer database of Surveillance,Epidemiology and End Results(SEER)database from 2010 to 2015.Randomly divided into training group(n=521)and validation group(n=218).The risk factors for cervical lymph node(CLN)metastasis and lateral cervical lymph node(LCLN)metastasis were analysed via multivariate Logistic regression.Nomograms were drawed based on the multivariate Logistic regression model for clinical prediction.ROC curves and calibration curves were used to analyze the regression model for differentiation and calibration.Results:In the training group,common risk factors associated with CLN metastasis and LCLN metastasis include gender,extrathyroidal extension(ETE),M stage,and tumor multifocality.T stage was a unique risk factor for CLN metastasis,and tumor size was a unique risk factor for LCLN metastasis.The AUC for the CLN and LCLN metastasis nomograms were 0.845(P<0.001)and 0.795(P<0.001)in the training group,while 0.803(P<0.001)and 0.828(P<0.001)respectively in the validation group.The calibration curves indicate that the good consistency of cervical lymph node metastasis between the actual observation and the model prediction(P>0.05).Conclusion:Based on the risk factors of lymph node metastasis,nomogram prediction models are constructed to help clinicians to personalize and quantify the likelihood of occult lymph node metastasis before surgery.The nomograms provide auxiliary guidance for patients whether to perform preventive lymph node dissection and determine the scope of the dissection.