目的：分析甲状腺乳头状癌（Papillary thyroid carcinoma，PTC）的临床、血清学及CT影像特征，发现其中与颈部中央区淋巴结转移相关的独立危险因素。方法：回顾性分析2017年1月—2019年5月在本院行甲状腺手术且术后免疫组化证实为PTC的患者126例，按照有无中央区淋巴结转移（Central lymphnode metastasis，CLNM）分为CLNM阳性组及CLNM阴性组，应用单因素及Logistic逐步回归分析两组病例的临床、血清学及CT影像特征，确定影响颈部CLNM的独立危险因素，采用列线图对预测模型结果进行可视化展示，并采用ROC曲线对预测模型进行评估。结果：65例CLNM阳性组与61例CLNM阴性组单因素分析显示：年龄、肿瘤最大径、肿瘤部位、静脉期CT值、多病灶、微钙化、包膜侵犯和TSH与CLNM相关（P＜0.05）。模型优化最终将年龄、癌症部位、静脉期CT值、多病灶、微钙化和包膜侵犯纳入到预测模型。基于Logistic逐步回归筛选的独立危险因素建立列线图，AUC为0.806，特异性为0.705，敏感性为0.769。结论：患者年龄越小、位于中叶、CT值（静脉期）强化低、多病灶、微钙化和包膜侵犯是PTC CLNM的独立危险因素。
Abstract
Objective: To analyze the clinical, serological and CT features of papillary carcinoma(PTC) and search independent risk factors associated with lymph node metastasis in the central region of neck. Methods: One hundred and twenty-six cases in our hospital confirmed for PTC by immunohistochemistry after thyroid surgery from January 2017 to May 2019 were divided into central lymph node metastasis(CLNM) positive group and CLNM negative group according to the presence of lymph node metastasis in central region. Then clinical, serological and CT imaging features of the two groups were analyzed by single factor and Logistic stepwise regression to determine independent risk factors responsible for cervical lymph node metastasis in the central region of neck. The results of the prediction model were visualized by using nomograms, and the prediction model was evaluated by using ROC curve. Results: The result showed that age, tumor maximum diameter, tumor site, venous CT value, multiple lesions, microcalcification, capsule invasion, thyroglobulin(Tg) and thyroid stimulating hormone(TSH) were significantly correlated with CLNM(P<0.05) according to single factor analysis of 65 cases of CLNM positive group and 61 cases of CLNM negative group. The model optimization ultimately included age, cancer site, venous CT value, multiple lesions, microcalcification, and envelope invasion into the prediction model. The nomogram was established based on independent risk factors selected by Logistic stepwise regression, with AUC of 0.806, specificity of 0.705 and sensitivity of 0.769. Conclusion: The younger the age of the patients, the middle stage, low CT value(venous stage) enhancement, multiple lesions, microcalcification and capsule invasion are independent risk factors for lymph node metastasis in the central region of PTC.
关键词
甲状腺肿瘤 /
癌 /
乳头状 /
体层摄影术 /
螺旋计算机
Key words
Thyroid neoplasms /
Carcinoma, papillary /
Tomography, spiral computed
中图分类号：
Ｒ736.1
Ｒ730.261
Ｒ445.2
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