刘欢, 晋建华. DTC远处转移的危险因素分析及列线图预测模型的建立[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202304041-00423
引用本文: 刘欢, 晋建华. DTC远处转移的危险因素分析及列线图预测模型的建立[J]. 国际放射医学核医学杂志. DOI: 10.3760/cma.j.cn121381-202304041-00423
Liu Huan, Jin Jianhua. Analysis of the risk factors and establishment of a nomogram prediction model in patients with differentiated thyroid cancer and distant metastasis[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202304041-00423
Citation: Liu Huan, Jin Jianhua. Analysis of the risk factors and establishment of a nomogram prediction model in patients with differentiated thyroid cancer and distant metastasis[J]. Int J Radiat Med Nucl Med. DOI: 10.3760/cma.j.cn121381-202304041-00423

DTC远处转移的危险因素分析及列线图预测模型的建立

Analysis of the risk factors and establishment of a nomogram prediction model in patients with differentiated thyroid cancer and distant metastasis

  • 摘要:
    目的  探讨分化型甲状腺癌(DTC)患者发生远处转移的危险因素,构建远处转移的列线图预测模型并验证其预测价值。
    方法  回顾性分析2018年12月至2021年12月山西医科大学第一医院收治的655例DTC患者的临床及组织病理学检查结果等资料,其中男性221例、女性434例,年龄(44.4±11.5)岁,范围10~77岁。通过单因素分析确定DTC患者远处转移的危险因素,采用受试者工作特征(ROC)曲线确定最佳临界值。通过多因素Logistic回归分析确定DTC患者远处转移的独立危险因素,并构建远处转移的列线图预测模型。通过ROC曲线、校准曲线和临床决策曲线分析(DCA)评估模型的区分度、校准度和临床效能。
    结果  单因素分析结果显示,性别、年龄、病理类型、肿瘤最大径、包膜或甲状腺外侵犯、脉管癌栓、颈侧区淋巴结转移、颈侧区合并中央区淋巴结转移、转移淋巴结数量、首次131I治疗距离手术时间、131I治疗前刺激性甲状腺球蛋白(sTg)水平为DTC发生远处转移的危险因素(OR=0.448~34.239,均P<0.05)。年龄、肿瘤最大径、转移淋巴结数目、131I治疗距离手术时间、sTg预测远处转移的最佳临界值分别为55岁曲线下面积(AUC)为0.548,95%CI:0.452~0.643、2 cm(AUC为0.740,95%CI:0.663~0.818)、6个(AUC为0.684,95%CI:0.605~0.764)、3个月(AUC为0.625,95%CI:0.548~0.702)、19.43 ng/ml(AUC为0.927,95%CI:0.886~0.967)。多因素分析结果表明,年龄≥55岁、肿瘤最大径≥2 cm、转移淋巴结数量≥6个以及131I治疗前sTg≥19.43 ng/ml是DTC发生远处转移的独立危险因素(OR=3.427~34.239,均P<0.05)。构建的列线图预测模型具有较好的预测效能,即良好的区分度(AUC为9.20,95%CI:0.877~0.963)和校准度(平均绝对误差=0.007)。临床DCA结果表明,模型的临床效能较好。
    结论  年龄≥55岁、肿瘤最大径≥2 cm、转移淋巴结数量≥6个以及131I治疗前sTg≥19.43 ng/ml是预测DTC发生远处转移的独立危险因素,以此建立的列线图预测模型效能良好,可作为临床个性化评估DTC患者131I治疗前发生远处转移风险的工具。

     

    Abstract:
    Objective  To investigate the risk factors associated with distant metastasis in patients diagnosed with differentiated thyroid cancer (DTC), and establish construct a nomogram prediction model for distant metastasis and validate its predictive value.
    Methods  The clinical and histopathological data of 655 patients with DTC admitted to the First Hospital of Shanxi Medical University from December 2018 to December 2021 were retrospectively analyzed. The patients including 221 males and 434 females, aged(44.4±11.5) years old, range from 10 to 77 years old. The risk factors for distant metastases in patients with DTC were determined through single factor analysis, and the optimal cutoff values were established using receiver operating characteristic (ROC) curve analysis. Multivariate logistic regression analysis was employed to identify independent risk factors for distant metastases in DTC patients, and a nomogram prediction model was developed. Assess the model's discrimination, calibration, and clinical utility by analyzing ROC curves, calibration curves and clicinal decision curve analysis (DCA).
    Results  the cut-off values of age, maximum tumor diameter, number of metastatic lymph nodes, the interval between the first 131I treatment and operation, and sTg for predicting distant metastasis were 55 years old ((area under the curve, AUC)=0.548, 95%CI: 0.452−0.643) and 2 cm (AUC=0.740, 95%CI: 0.663−0.818), 6 (AUC=0.684, 95%CI: 0.605-0.764), 3 months (AUC=0.625, 95%CI:0.548−0.702), 19.43 ng/ml(AUC=0.927, 95%CI: 0.886−0.967). Univariate analysis indicated that gender, age, pathological type, maximum diameter of tumor, capsule or extrathyroidal extension, vascular tumor thrombus, lateral cervical lymph node metastasis, lateral cervical lymph node metastasis combined with central lymph node metastasis, number of metastatic lymph nodes, the interval between the first 131I treatment and operation, and stimulated thyroglobulin (sTg) level before 131I treatment were factors for predicting distant metastasis of DTC(OR=0.448-34.239, all P<0.05). Multivariate analysis showed that age ≥55 years old, maximum tumor diameter ≥2 cm, number of metastatic lymph nodes ≥6 and sTg≥19.43 ng/ml were independent risk factors for distant metastasis of DTC (OR= 3.427−34.239, all P<0.05). The constructed nomogram prediction model had good predictive performance, namely good discrimination (AUC=9.20, 95%CI: 0.877-0.963) and calibration (mean absolute error =0.007). Clicinal DCA showed that the model had better clinical efficacy.
    Conclusions  Age ≥55 years old, maximum tumor diameter ≥2 cm, number of metastatic lymph nodes≥6 and sTg≥19.43 ng/ml are independent risk factors for predicting distant metastasis of DTC, and the nomogram prediction model established based on these factors has good effect. It can serve as a valuable tool for personalized clinical assessment of the risk of distant metastasis in DTC patients prior to 131I treatment.

     

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