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Title: [Establishment and validation of a nomogram model for evaluating the metastasis of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma].
Author: Wang ZY, Chang QG, Guo HH, Du X, Liu YH, Yin DT.
Journal: Zhonghua Yi Xue Za Zhi; 2023 Jul 25; 103(28):2175-2182. PubMed ID: 37482730.
Abstract:
Objective: To explore the related factors of lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in papillary thyroid carcinoma (PTC) and establish a nomogram model for evaluating LN-prRLN metastasis. Methods: The clinical data of patients with PTC who underwent surgery in the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from January 2020 to December 2021 were retrospectively analyzed. Multivariate logistic regression was used to analyze the related factors of LN-prRLN metastasis and construct a nomogram model for evaluating LN-prRLN metastasis. Meanwhile, the data of 120 patients from January to June 2022 were also collected for external verification. Results: A total of 466 patients with PTC were enrolled, including 106 males and 360 females, and aged 44 (33, 53) years. There were 280 cases in the training group and 186 cases in the internal validation group, respectively. Multivariate logistic regression analysis showed that age (OR=0.966, 95%CI: 0.938-0.996, P=0.027), tumor size (OR=1.048, 95%CI: 1.001-1.098, P=0.043), multifocality (OR=2.459, 95%CI: 1.268-4.767, P=0.008), right central lymph node metastasis reported by ultrasound (OR=3.099, 95%CI: 1.255-7.651, P=0.014), extrathyroid extension (OR=3.561, 95%CI: 1.255-10.102, P=0.017) and serum thyroglobulin level (OR=1.010, 95%CI: 1.001-1.018, P=0.032) were related factors for LN-prRLN metastasis. The area under the curve (AUC) values of receiver operating characteristic (ROC) curves of the training group, internal validation group and external validation group were 0.765 (95%CI: 0.691-0.840), 0.747 (95%CI: 0.657-0.837) and 0.754 (95%CI: 0.639-0.869), respectively. Conclusion: Dissection of the LN-prRLN is recommended for young PTC patients with large tumor size, multifocality, right central lymph node metastasis reported by ultrasound, extrathyroid extension and high serum thyroglobulin level. 目的： 探讨甲状腺乳头状癌（PTC）患者右侧喉返神经深层淋巴结（LN-prRLN）转移的相关因素，并建立评估LN-prRLN转移的列线图模型。 方法： 回顾性分析2020年1月至2021年12月于郑州大学第一附属医院甲状腺外科行手术治疗的PTC患者临床资料，使用多因素logistic回归分析LN-prRLN转移的相关因素，构建列线图模型，并收集甲状腺外科2022年1至6月的120例患者资料进行外部验证。 结果： 纳入466例PTC患者，男106例，女360例，年龄M（Q₁，Q₃）44（33，53）岁，训练组280例，内部验证组186例。多因素logistic回归分析结果显示，年龄（OR=0.966，95%CI：0.938~0.996，P=0.027）、肿瘤大小（OR=1.048，95%CI：1.001~1.098，P=0.043）、多灶（OR=2.459，95%CI：1.268~4.767，P=0.008）、超声报告右中央区淋巴结转移（OR=3.099，95%CI：1.255~7.651，P=0.014）、腺外侵犯（OR=3.561，95%CI：1.255~10.102，P=0.017）和血清甲状腺球蛋白水平（OR=1.010，95%CI：1.001~1.018，P=0.032）是LN-prRLN转移的相关因素。训练组、内部验证组和外部验证组受试者工作特征（ROC）曲线的曲线下面积分别为0.765（95%CI：0.691~0.840）、0.747（95%CI：0.657~0.837）和0.754（95%CI：0.639~0.869）。 结论： 对于肿瘤直径大、多灶、超声报告右中央区淋巴结转移、腺外侵犯及血清甲状腺球蛋白水平高的年轻PTC患者，建议行LN-prRLN清扫。.

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