■这项研究的目的是开发一个列线图,血清胸苷激酶1蛋白(STK1p)结合超声参数,早期预测甲状腺乳头状癌(PTC)患者术前中央区淋巴结转移(CLNM)。
■2021年1月至2023年2月的PTC术前患者分为三个队列:观察队列(CLNM,n=140),对照组(NCLNM,n=128),和外部验证队列(CLNM,n=50;NCLNM,n=50)。通过酶免疫斑点印迹化学发光分析仪检测STK1p,并通过超声检查评估临床参数。
■选择1.7pmol/L的STK1p的合适风险阈值,用于通过受试者工作特征(ROC)曲线分析预测CLNM风险。多变量分析确定了以下六个CLNM的独立危险因素:最大肿瘤大小>1cm[比值比(OR)=2.406,95%置信区间(CI)(1.279-4.526),p=0.006];胶囊侵入[OR=2.664,95%CI(1.324-5.360),p=0.006];不规则边缘[OR=2.922;95%CI(1.397-6.111),p=0.004];CLN流量信号[OR=3.618,95%CI(1.631-8.027),p=0.002];肿瘤病灶数≥2[OR=4.064,95%CI(2.102-7.859),p<0.001];STK1p≥1.7pmol/L[OR=7.514,95%CI(3.852-14.660),p<0.001]。构建的列线图显示,主数据集的ROC曲线下面积为0.867,验证数据集为0.830,表现出有效性。并重新计算至总分约383分。通过监测手术后的反应,所有患者在术后12个月评估为无瘤,这与STK1p降低至无病水平显着相关。
■我们首次证明,包括STK1p结合超声检查的新型列线图可以帮助临床预防CLNM,通过及时促进,个体化预防性CLNM夹层,从而降低二次手术的风险和复发的可能性。
UNASSIGNED: The aim of this study was to develop a nomogram, using serum thymidine kinase 1 protein (STK1p) combined with ultrasonography parameters, to early predict central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) pre-surgery.
UNASSIGNED: Patients with PTC pre-surgery in January 2021 to February 2023 were divided into three cohorts: the observation cohort (CLNM, n = 140), the control cohort (NCLNM, n = 128), and the external verification cohort (CLNM, n = 50; NCLNM, n = 50). STK1p was detected by an enzyme immunodot-blot chemiluminescence analyzer and clinical parameters were evaluated by ultrasonography.
UNASSIGNED: A suitable risk threshold value for STK1p of 1.7 pmol/L was selected for predicting CLNM risk by receiver operating characteristic (ROC) curve analysis. Multivariate analysis identified the following six independent risk factors for CLNM: maximum tumor size >1 cm [odds ratio (OR) = 2.406, 95% confidence interval (CI) (1.279-4.526), p = 0.006]; capsule invasion [OR = 2.664, 95% CI (1.324-5.360), p = 0.006]; irregular margin [OR = 2.922; 95% CI (1.397-6.111), p = 0.004]; CLN flow signal [OR = 3.618, 95% CI (1.631-8.027), p = 0.002]; tumor-foci number ≥2 [OR = 4.064, 95% CI (2.102-7.859), p < 0.001]; and STK1p ≥1.7 pmol/L [OR = 7.514, 95% CI (3.852-14.660), p < 0.001]. The constructed nomogram showed that the area under the ROC curve for the main dataset was 0.867 and that for the validation dataset was 0.830, exhibiting effectivity, and was recalculated to a total score of approximately 383. Through monitoring the response post-surgery, all patients were assessed as tumor-free at 12 months post-surgery, which was significantly associated with a reduction in STK1p to disease-free levels.
UNASSIGNED: We demonstrate for the first time that a novel nomogram including STK1p combined with ultrasonography can assist in the clinical prevention of CLNM, by facilitating timely, individualized prophylactic CLNM dissection, thereby reducing the risk of secondary surgery and the probability of recurrence.