基于SEER数据库构建甲状腺微小乳头状癌颈部淋巴结转移术前预测模型-现代医学

基于SEER数据库构建甲状腺微小乳头状癌颈部淋巴结转移术前预测模型

单位：1. 武汉科技大学医学院, 湖北武汉 430000;
2. 黄石市中心医院(湖北理工学院附属医院) 乳腺甲状腺外科/肾脏疾病发生与干预湖北省重点实验室, 湖北黄石 435000]

分类号：R736.1

出版年·卷·期（页码）：2023·51·第十一期（1511-1519）

摘要：

目的：探讨影响甲状腺微小乳头状癌(PTMC)患者颈部区域淋巴结转移的临床因素，并构建转移风险预测模型。方法：回顾性分析监测、流行病学和最终结果(SEER)数据库2008—2015年诊断为PTMC的13 355例患者临床病例资料，按7 ∶ 3比例分为训练集与内部验证集，黄石市中心医院2019—2021年乳腺甲状腺外科诊治的410例患者数据为外部验证集。训练集中，通过单变量、多变量Logistic回归分析确定PTMC颈部淋巴结转移的独立预测因子，使用R软件构建预测模型，使用受试者操作特征(ROC)曲线下面积(AUC)评估预测能力，通过校准图评估模型准确性，进行内外部验证。再利用临床决策曲线(DCA)评估临床实用性和净收益。结果：多因素回归分析显示男性、年龄<55岁、肿瘤最大直径≥5 mm、其它人种、肿瘤多灶性、腺外浸润是PTMC患者颈淋巴结转移的独立危险因素(P<0.05),基于以上多变量构建的预测模型C指数为0.715，显示有良好的预测能力。在训练集、内、外部验证集中，该预测模型的预测结果和实际情况具有良好的一致性。结论：基于SEER数据库研究PTMC患者颈部淋巴结转移的影响因素并构建列线图，且进行内、外部验证，证明此模型有良好的预测能力与临床实用性，可以帮助临床医师直观的评估PTMC患者颈淋巴结转移率，制定个体化治疗方案。

Objective: To investigate the clinical factors that affect cervical lymph node metastasis in patients with papillary thyroid microcarcinoma(PTMC), and to construct a metastasis risk prediction model. Methods: The clinical data of 13 355 patients diagnosed as PTMC in the Surveillance, Epidemiology, and End Results(SEER) database from 2008 to 2015 were retrospectively analyzed, which were divided into training set and internal validation set according to the ratio of 7 : 3, and the data of 410 patients diagnosed and treated in the breast and thyroid surgery of Huangshi Central Hospital from 2019 to 2021 were used as the external validation set. In the training set, independent predictors of cervical lymph node metastasis in PTMC were determined through univariate and multivariate Logistic regression analysis. A prediction model was constructed using R software, and the predictive ability was evaluated using the area under the receiver operating characteristic(ROC)curve. The accuracy of the model was evaluated through calibration plots, and internal and external validation was conducted. The decision curve analysis(DCA) was reused to evaluate clinical practicality and net income.Results: Multivariate regression analysis showed that male, age<55 years old, maximum tumor diameter ≥ 5 mm, other race of people, multifocal tumor and extraglandular infiltration were independent risk factors for cervical lymph node metastasis in PTMC patients(P<0.05). The prediction model constructed based on the above multivariate analysis had a C index of 0.715, indicating good predictive ability. The prediction results of this prediction model had good consistency with the actual situation in the training set, internal and external validation sets. Conclusion: Based on the SEER database, the influencing factors of cervical lymph node metastasis in PTMC patients are studied and a column chart is constructed. Internal and external validation is conducted, proving that this model has good predictive ability and clinical practicality. It can help clinical physicians intuitively evaluate the cervical lymph node metastasis rate of PTMC patients and develop personalized treatment plans.

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