目的:分析甲状腺癌术后新发一过性声带麻痹(VCP)的影响因素。
方法:对2018年1月至2020年12月XX年住院的8340例甲状腺癌患者的病例资料进行回顾性分析。可能的影响因素采用卡方检验进行分析,秩和检验,和多元Logistic回归分析。使用列线图构建临床预测模型,并通过ROC在验证集中进行验证,校正曲线,DCA。
结果:遵循STROCSS指南进行回顾性队列研究。共有8340名患者,包括1,817(21.8%)男性和6,523(78.2%)女性,参加了这项研究。临时VCP的发生率为3.6%(308/8,340)。根据术后喉镜检查的结果,将患者分为VCP组和非VCP组。组间比较分析显示,与术后短暂性VCP相关的潜在因素为肿瘤位于腺体背侧(P=0.042),超声显示最大结节直径>1厘米(P=0.002),多灶性癌(P<0.001),侵犯周围组织(P=0.005),中央区淋巴结转移(P=0.034),侧颈淋巴结转移(P<0.001),延长手术时间(P<0.001)。多因素logistic回归分析显示,术后短暂性VCP的独立危险因素为T分期(OR=1.411,P=0.013,95%CI:1.075~1.853)。多灶性癌(OR=1.532,P=0.013,95%CI:1.095-2.144),和手术时间(OR=1.009,P<0.001,95%CI:1.006-1.012)。最后,通过列线图建立临床预测模型,并在验证集中进行验证,尽管其诊断效能有待进一步提高。
结论:高T期,多灶性癌,手术时间延长可能是甲状腺癌初次手术患者术后一过性VCP发生的独立危险因素。
OBJECTIVE: To analyze the potential factors influencing new-onset postoperative transient vocal cord paralysis (VCP) in thyroid cancer patients.
METHODS: Case information of 8340 thyroid cancer patients hospitalized at
China-Japan Union Hospital of Jilin University, Jilin Province,
China, in the Thyroid Surgery Department from January 2018 to December 2020 was collected retrospectively and analyzed. The possible influencing factors were analyzed using a χ2 test, rank-sum test, and multiple logistic regression analysis. A nomogram was used to construct the clinical prediction model that was validated in the validation set by receiver operating characteristic, calibration curves, and Decision curve analysis.
RESULTS: The strengthening the reporting of cohort, cross-sectional, and case-control studies in surgery (STROCSS) guideline was followed to conduct a retrospective cohort study. A total of 8340 patients, including 1817 (21.8%) men and 6523 (78.2%) women, were enrolled in this study. The rate of temporary VCP was 3.6% (308/8340). Based on the results of postoperative laryngoscopy, the patients were divided into VCP group and non-VCP group. Comparative analysis between the groups revealed that potential factors associated with postoperative transient VCP were tumor location on the dorsal side of the gland ( P =0.042), ultrasound showing a maximum nodal diameter >1 cm ( P =0.002), multifocal carcinoma ( P <0.001), invasion of surrounding tissue ( P =0.005), lymph node metastases in the central compartment ( P =0.034), lateral cervical lymph node metastasis ( P <0.001), and prolonged operation ( P <0.001). A multiple logistic regression analysis showed that the independent risk factors in postoperative transient VCP were T stage (OR=1.411, P =0.013, 95% CI: 1.075-1.853), multifocal carcinoma (OR=1.532, P =0.013, 95% CI: 1.095-2.144), and duration of surgery (OR=1.009, P <0.001, 95% CI: 1.006-1.012). Finally, a clinical prediction model was established via a nomogram and was validated in the validation set, although its diagnostic efficacy needs to be improved further.
CONCLUSIONS: High T stage, multifocal carcinoma, and prolonged operation time may be independent risk factors for the occurrence of postoperative transient VCP in patients undergoing initial surgery for thyroid cancer.