术前血清甲状腺球蛋白和抗甲状腺球蛋白抗体对cN0乳头状甲状腺癌中心室淋巴结转移的预测价值

摘要(中文译文)

探讨术前血清甲状腺球蛋白（Tg）及抗甲状腺球蛋白抗体（TgAb）对临床淋巴结阴性（cN0）甲状腺乳头状癌（PTC）患者中央区淋巴结转移（CLNM）的预测价值。回顾性分析2018年1月至2023年12月于我院行甲状腺全切术联合中央区淋巴结清扫的cN0 PTC患者的临床资料。按7：3比例将患者随机分为训练队列和验证队列。收集的数据包括患者人口学特征、临床病理特征及术前血清Tg和TgAb水平。结局指标为病理证实的CLNM状态。采用单因素和多因素logistic回归分析筛选CLNM的独立预测因素。通过受试者工作特征（ROC）曲线分析评估术前血清Tg、TgAb及所构建预测模型对CLNM的预测价值。共纳入790例患者，其中训练队列553例，验证队列237例。CLNM总体发生率为37.7%（298/790）。在训练队列中，CLNM组术前血清Tg和TgAb水平显著高于非CLNM组（P < 0.05）。多因素logistic回归分析确定年龄<45岁（OR = 1.675）、肿瘤最大径≥1 cm（OR = 2.348）、包膜侵犯（OR = 2.757）、术前血清Tg ≥ 34.7 ng/mL（OR = 2.257）、术前血清TgAb ≥ 62.6 IU/mL（OR = 1.796）及log10（Tg/TgAb + 1）≥ 0.21（OR = 2.409）为CLNM的独立预测因素（P < 0.05）。纳入上述六项因素构建的预测模型在训练队列和验证队列中预测CLNM的AUC分别为0.863和0.819。术前血清Tg和TgAb是cN0 PTC患者CLNM的独立预测因素。将该血清学标志物与临床病理特征相结合的预测模型表现出良好的预测效能，可为cN0 PTC患者是否需行预防性中央区淋巴结清扫的临床决策提供有价值的参考。

Abstract

To investigate the predictive value of preoperative serum thyroglobulin (Tg) and anti-thyroglobulin antibodies (TgAb) for central compartment lymph node metastasis (CLNM) in patients with clinically node-negative (cN0) papillary thyroid carcinoma (PTC). A retrospective analysis was conducted on clinical data from patients with cN0 PTC who underwent total thyroidectomy with central compartment lymph node dissection at our hospital between January 2018 and December 2023. Patients were randomly divided into a training cohort and a validation cohort in a 7:3 ratio. Data collected included patient demographics, clinicopathological characteristics, and preoperative serum Tg and TgAb levels. The outcome measure was pathologically confirmed CLNM status. Univariate and multivariate logistic regression analyses were employed to identify independent predictors of CLNM. The predictive value of preoperative serum Tg, TgAb, and the constructed prediction model for CLNM was assessed using receiver operating characteristic (ROC) curve analysis. A total of 790 patients were enrolled in this study, comprising 553 in the training cohort and 237 in the validation cohort. The overall incidence of CLNM was 37.7% (298/790). In the training cohort, preoperative serum Tg and TgAb levels were significantly higher in the CLNM group compared to the non-CLNM group ( < 0.05). Multivariate logistic regression analysis identified age <45 years (OR = 1.675), maximal tumor diameter ≥1 cm (OR = 2.348), capsular invasion (OR = 2.757), preoperative serum Tg ≥ 34.7 ng/mL (OR = 2.257), preoperative serum TgAb ≥62.6 IU/mL (OR = 1.796), and log10 (Tg/TgAb +1) ≥ 0.21 (OR = 2.409) as independent predictors of CLNM ( < 0.05). The prediction model incorporating these six factors yielded AUCs of 0.863 and 0.819 for predicting CLNM in the training and validation cohorts, respectively. Preoperative serum Tg and TgAb are independent predictors of CLNM in cN0 PTC patients. The prediction model, which combined these serological markers with clinicopathological characteristics demonstrates good predictive performance and may offer valuable guidance for clinical decision-making regarding the necessity of prophylactic central compartment lymph node dissection in cN0 PTC patients.

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