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Abstract：
Thyroid cancer is the most prevalent endocrine malignancy, with its global incidence increasing annually in recent years. Papillary carcinoma is the most common subtype, frequently accompanied by cervical lymph node metastasis early on. Central lymph node metastasis (CLNM) is particularly the common metastasis form in this subtype, and the presence of lymph node metastasis correlates strongly with tumor recurrence. However, effective preoperative assessment methods for CLNM in patients with papillary thyroid carcinoma (PTC) remain lacking.
Data from 400 patients diagnosed with PTC between January 1, 2018, and January 1, 2022, at the Shandong Provincial Hospital were retrospectively analyzed. This data included clinicopathological information of the patients, such as thyroid function, BRAF V600E mutation, whether complicated with Hashimoto\'s thyroiditis, and the presence of capsular invasion. Univariate and multivariate logistic regression analyses were performed to assess the risk factors associated with cervical CLNM in patients with PTC. Subsequently, a clinical prediction model was constructed, and prognostic risk factors were identified based on univariate and multivariate Cox regression analyses.
Univariate and multivariate analyses identified that age >45 years (P=0.014), body mass index ≥25 (P=0.008), tumor size ≥1 cm (P=0.001), capsular invasion (P=0.001), and the presence of BRAF V600E mutation (P<0.001) were significantly associated with an increased risk of CLNM. Integrating these factors into the nomogram revealed an area-under-the-curve of 0.791 (95% confidence interval 0.735-0.846) and 0.765 (95% confidence interval: 0.677-0.852) for the training and validation sets, respectively, indicating strong discriminative abilities. Subgroup analysis further confirmed that patients with papillary thyroid microcarcinoma and BRAF V600E mutations who underwent therapeutic central compartment neck dissection had significantly better 3-year disease-free survival than those who had prophylactic central compartment neck dissection (P<0.001).
The study revealed that age >45 years, body mass index ≥25, tumor size ≥1 cm, BRAF V600E mutation, and capsular invasion are the related risk factors for CLNM in patients with PTC. For patients with clinically nodal-negative (cN0) papillary thyroid microcarcinoma, accurately identifying the BRAF V600E mutation is essential for guiding the central lymph node dissection approach and subsequent treatments.
Data from 400 patients diagnosed with PTC between January 1, 2018, and January 1, 2022, at the Shandong Provincial Hospital were retrospectively analyzed. This data included clinicopathological information of the patients, such as thyroid function, BRAF V600E mutation, whether complicated with Hashimoto\'s thyroiditis, and the presence of capsular invasion. Univariate and multivariate logistic regression analyses were performed to assess the risk factors associated with cervical CLNM in patients with PTC. Subsequently, a clinical prediction model was constructed, and prognostic risk factors were identified based on univariate and multivariate Cox regression analyses.
Univariate and multivariate analyses identified that age >45 years (P=0.014), body mass index ≥25 (P=0.008), tumor size ≥1 cm (P=0.001), capsular invasion (P=0.001), and the presence of BRAF V600E mutation (P<0.001) were significantly associated with an increased risk of CLNM. Integrating these factors into the nomogram revealed an area-under-the-curve of 0.791 (95% confidence interval 0.735-0.846) and 0.765 (95% confidence interval: 0.677-0.852) for the training and validation sets, respectively, indicating strong discriminative abilities. Subgroup analysis further confirmed that patients with papillary thyroid microcarcinoma and BRAF V600E mutations who underwent therapeutic central compartment neck dissection had significantly better 3-year disease-free survival than those who had prophylactic central compartment neck dissection (P<0.001).
The study revealed that age >45 years, body mass index ≥25, tumor size ≥1 cm, BRAF V600E mutation, and capsular invasion are the related risk factors for CLNM in patients with PTC. For patients with clinically nodal-negative (cN0) papillary thyroid microcarcinoma, accurately identifying the BRAF V600E mutation is essential for guiding the central lymph node dissection approach and subsequent treatments.
摘要：
■甲状腺癌是最常见的内分泌恶性肿瘤，近年来，其全球发病率逐年上升。乳头状癌是最常见的亚型，早期常伴有颈淋巴结转移。中央区淋巴结转移(CLNM)尤其是该亚型的常见转移形式。淋巴结转移与肿瘤复发密切相关。然而,甲状腺乳头状癌（PTC）患者的CLNM的有效术前评估方法仍然缺乏。
■对山东省立医院2018年1月1日至2022年1月1日诊断为PTC的400例患者的数据进行回顾性分析。这些数据包括患者的临床病理信息，比如甲状腺功能，BRAFV600E突变,是否患有桥本甲状腺炎，和包膜侵入的存在。采用单因素和多因素logistic回归分析评估PTC患者宫颈CLNM的相关危险因素。随后，建立了临床预测模型，并根据单因素和多因素Cox回归分析确定预后危险因素.
■单变量和多变量分析确定年龄>45岁（P=0.014），体重指数≥25（P=0.008），肿瘤大小≥1cm（P=0.001），包膜浸润（P=0.001），BRAFV600E突变的存在(P<0.001)与CLNM风险增加显著相关。将这些因素整合到列线图中，显示出训练集和验证集的曲线下面积为0.791（95％置信区间0.735-0.846）和0.765（95％置信区间：0.677-0.852），分别,表明有很强的辨别能力。亚组分析进一步证实，甲状腺微小乳头状癌和BRAFV600E突变患者接受治疗性中央室颈清扫术的3年无病生存率明显优于预防性中央室颈清扫术的患者(P<0.001)。
■研究显示年龄>45岁，体重指数≥25，肿瘤大小≥1cm，BRAFV600E突变,包膜侵犯是PTC患者发生CLNM的相关危险因素。对于临床淋巴结阴性（cN0）甲状腺乳头状微癌患者，准确识别BRAFV600E突变对于指导中央区淋巴结清扫方法和后续治疗至关重要.
■对山东省立医院2018年1月1日至2022年1月1日诊断为PTC的400例患者的数据进行回顾性分析。这些数据包括患者的临床病理信息，比如甲状腺功能，BRAFV600E突变,是否患有桥本甲状腺炎，和包膜侵入的存在。采用单因素和多因素logistic回归分析评估PTC患者宫颈CLNM的相关危险因素。随后，建立了临床预测模型，并根据单因素和多因素Cox回归分析确定预后危险因素.
■单变量和多变量分析确定年龄>45岁（P=0.014），体重指数≥25（P=0.008），肿瘤大小≥1cm（P=0.001），包膜浸润（P=0.001），BRAFV600E突变的存在(P<0.001)与CLNM风险增加显著相关。将这些因素整合到列线图中，显示出训练集和验证集的曲线下面积为0.791（95％置信区间0.735-0.846）和0.765（95％置信区间：0.677-0.852），分别,表明有很强的辨别能力。亚组分析进一步证实，甲状腺微小乳头状癌和BRAFV600E突变患者接受治疗性中央室颈清扫术的3年无病生存率明显优于预防性中央室颈清扫术的患者(P<0.001)。
■研究显示年龄>45岁，体重指数≥25，肿瘤大小≥1cm，BRAFV600E突变,包膜侵犯是PTC患者发生CLNM的相关危险因素。对于临床淋巴结阴性（cN0）甲状腺乳头状微癌患者，准确识别BRAFV600E突变对于指导中央区淋巴结清扫方法和后续治疗至关重要.
