| Objective: To analyse the risk factors for central lymph node metastasis in patients with papillary thyroid cancer combined with Hashimoto’s thyroiditis based on clinical characteristics.And a risk prediction model for central lymph node metastasis,will help the surgeons to visualise the status of lymph node metastasis in the central region and plan a batter treatment.Methods: A retrospective analysis of 114 patients with postoperative pathological diagnosis of papillary thyroid carcinoma combined with Hashimoto’s thyroiditis who were operated on in the Department of Breast and Thyroid Surgery,The First Affiliated Hospital of Henan University from August2020 to August 2022.The patients were divided into the group with lymph node metastasis in the central region(49 patients)and the group without lymph node metastasis in the central region(65 patients),and the gender,age,ultrasound image characteristics,thyroid stimulating hormone(TSH),thyroid peroxide antibody(TPOAb)and thyroglobulin antibody(Tg Ab)of the two groups were analysed by univariate analysis.The variables that were significant in the univariate analysis were subjected to multivariate logistic regression analysis to screen for independent risk factors for lymph node metastasis in the central region.Regression equations were constructed and line graph models,receiver operating characteristics(ROC)and calibration curves were plotted to evaluate the discrimination and calibration of the model.Decision curve analysis(DCA)to evaluate clinical usefulness.A Delong test was conducted to investigate the effect of the inclusion of gender and age variables on the model(Model A),and a model B was constructed by calculating the net reclassification improvement(NRI)and the integrated discrimination improvement(IDI).The analysis was validated by randomly dividing into a modeling group and a validation group according to a 7:3 ratio.Results: There were statistically significant differences(P<0.05)in age(P=0.045),calcification(P=0.002),aspect ratio(P=0.007),number of nodule(P=0.015),maximum diameter of nodule(P<0.001),perineural invasion(P=0.001)and enlarged lymph nodes in the neck(P=0.004),Tg Ab(P=0.007)between the two groups.No statistically significant differences were found between the two groups for gender(P=0.794),nodule border(P=0.671),nodule morphology(P=0.105),internal structure(P=0.870),nodule accumulation in the glandular lobes(P=0.417),diffuse enlargement of thyroid parenchyma(P=0.271),TSH(P=0.110)and TPOAb(P=0.076)(P>0.05).Age,calcification,aspect ratio,cervical lymph node enlargement,number of nodule,maximum diameter of nodule,perineural invasion and Tg Ab,which were statistically significant in the univariate analysis,were subjected to multi-factor logistic regression analysis.The results showed that the presence of calcification,aspect ratio ≥ 1,neck lymph node enlargement,nodule>1cm in maximum diameter and perineural invasion were independent risk factors for the development of lymph node metastasis in the central region in patients with papillary thyroid cancer combined with Hashimoto’s thyroiditis.The regression equation was constructed: logit(P)=-4.565 +1.792X1 + 1.360X2 + 1.135X3 + 1.467X4 + 1.433X5(X1: calcification;X2: aspect ratio;X3: neck lymph node enlargement;X4: maximum diameter of cancer foci;X5: perineural invasion).The area under the ROC curve of this prediction model was 0.851,and the Hosmer-Lemeshow goodness-of-fit test P=0.126>0.05,indicating that this model has good discrimination and calibration.The difference between Model B and Model A after the inclusion of the two variables of gender and age was not statistically significant(p=0.669>0.05).The modeling and validation groups were randomly divided into a 7:3 ratio to validate the prediction model(Model A).The modeling group Hosmer-Lemeshow goodness-of-fit test P=0.252>0.05 and AUC of 0.833 indicates that the model has good discrimination and calibration;the validation group Hosmer-Lemeshow goodness-of-fit test P=0.227 > 0.05 and AUC of 0.910 indicates that the model has good discrimination and calibration.Conclusion: Patients with papillary thyroid carcinoma combined with Hashimoto’s thyroiditis were at risk for lymph node metastasis in the central region with ultrasound suggestive of calcification,aspect ratio≥1,perineural invasion,nodule>1cm in maximum diameter and enlarged lymph nodes in the neck.The predictive model developed in this study can effectively assess the risk of lymph node metastasis in the central region in patients with papillary thyroid cancer combined with Hashimoto’s thyroiditis,reducing or avoiding prophylactic lymph node dissection in the central region and helping surgeons to made better treatment plans. |
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