| ObjectiveThrough the clinical analysis of patients with thyroid nodules in Jinzhou area,to understand the characteristics of thyroid cancer patients,to further explore the risk factors and the occurrence and development of thyroid cancer in patients with thyroid nodules,and to construct a prediction model,so as to provide scientific and reasonable reference for clinicians to identify benign and malignant thyroid nodules.MethodsUsing the method of current status survey,a questionnaire survey was conducted among patients who underwent thyroid surgery in the Department of Thyroid Surgery,the First Affiliated Hospital of Jinzhou Medical University from March 2021 to June 2022,and their relevant serological and thyroid ultrasound examination data were collected.According to the results of postoperative pathological diagnosis as the gold standard,the respondents were divided into benign thyroid nodules group and thyroid cancer group.SPSS 26.0 and R 4.2.2 statistical analysis software were used to analyze the data,and the differences in basic characteristics such as gender,age,ethnicity,occupation,education level,BMI,family history of disease,lifestyle habits,daily eating habits,serological indicators,and ultrasound imaging characteristics between the two groups were compared.t test or Mann-Whitney U test was used to compare the measurement data,χ2 test was used to compare the count data,and binaryLogistic regression was used to analyze the risk factors of thyroid cancer.According to the results of multivariate Logistic regression,a nomogram model was constructed by R language.The internal and external validation of the nomogram model were based on the randomly divided training set(n= 334)and validation set(n=143)data,and the receiver operating characteristic(ROC)curve,calibration curve and decision curve were drawn curve analysis(DCA)was used to further analyze the discrimination,calibration and clinical practicability of the model.Results1.Among the 477 patients who underwent thyroid nodule surgery,225 patients had benign thyroid nodules,accounting for 47.17%;There were 252 patients with thyroid cancer,accounting for 52.83%.There were 89 male patients,55 patients were thyroid cancer,accounting for 61.80%;There were 388 female patients,197(50.77%)were thyroid cancer patients.2.There were significant differences in the detection rate of thyroid cancer among different ages,occupations and education levels(P < 0.05).There were significant differences in the detection rate of thyroid cancer among different lifestyle habits(drinking,exercise,staying up late,stress and mobile phone use time)(P<0.05).Different dietary habits(meat consumption,poultry consumption,aquatic seafood consumption,vegetables consumption,dairy products consumption,calcium supplementation)had statistically significant differences in the detection rate of thyroid cancer(P<0.05).There was a significant difference in the detection rate of thyroid cancer between patients with family history of cancer(P <0.05).The detection rates of parathyroid hormone(PTH),thyrotropin(TSH)and thyroglobulin antibody(Tg Ab)for thyroid cancer were statistically significant(P<0.05).The ultrasonographic characteristics(boundary,shape,echo,abnormal cervical lymph nodes,nature of nodules,aspect ratio > 1)had statistically significant differences in the detection rate of thyroid cancer(P <0.05).3.Univariate Logistic regression analysis showed that: Age,occupation,education level,family history of cancer,drinking,staying up late,stress,meat,poultry,aquatic products and seafood,dairy products,TSH,TGAb,blurred edge,irregular shape,hypoechoic,abnormal cervical lymph nodes,nature of nodules,and aspect ratio greater than 1 were risk factors for thyroid cancer.Physical exercise and vegetable consumption were protective factors for thyroid cancer.4.The prediction equation can be obtained from the results of multivariate Logistic regression analysis as follows: Logit P=-2.255+1.355× Education level(college/university and above)+1.019× family history of tumors +0.632× stay up late +0.672× pressure +0.205×TSH+1.358× fuzzy boundary +0.847× irregular shape +1.155× hypoechoic +1.760× Solid nodules.5.In female patients,the detection rate of thyroid cancer was significantly different among different age at menarche,menopause,breast nodules and reproductive history(P<0.05).Univariate Logistic regression analysis showed that early age at menarche,menopause and childbearing history were protective factors for thyroid cancer,and breast nodules were risk factors for thyroid cancer.Multivariate analysis showed that menopause and childbearing history were protective factors for thyroid cancer,and breast nodules were independent risk factors for thyroid cancer.6.Based on multivariate Logistic regression analysis,a nomogram prediction model for determining the nature of thyroid nodules was established.the area under the ROC curve(AUC)of the training set and the validation set were 0.882 and 0.839,respectively,indicating that the nomogram prediction model had good discrimination ability.Conclusions1.In patients with thyroid nodules,The occurrence of thyroid cancer is related to age,occupation,education level,drinking,physical exercise,staying up late,stress,mobile phone use time,meat,poultry,aquatic seafood,dairy products,calcium supplementation,tumor family history,PTH,TSH,Tg Ab and ultrasound imaging features in the shape,edge,internal echo,nodule nature,aspect ratio and cervical lymph nodes Often related.2.In patients with thyroid nodules,the independent risk factors for thyroid cancer are college or above education,family history of cancer,staying up late,pressure,TSH,ultrasound showed fuzzy boundary,irregular shape,hypoechoic,solid nodules,etc.The above characteristics have important value in evaluating the benign and malignant thyroid nodules.3.In female patients with thyroid nodules,the independent risk factor for thyroid cancer is breast nodules,and the protective factors are menopause and childbearing history.4.The established nomogram prediction model can indicate the high-risk factors for clinical medical workers to intervene in patients with thyroid nodules,and provide more intuitive clinical reference for the determination of benign and malignant thyroid nodules when fine needle aspiration biopsy can not be performed or the biopsy results are uncertain. |
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