儿童及青少年甲状腺乳头状癌侧颈淋巴结转移术前预测列线图：多中心回顾性研究
该多中心回顾性研究纳入300例儿童及青少年甲状腺乳头状癌患者，基于年龄、多灶性、血管化及与甲状腺被膜关系构建术前预测侧颈淋巴结转移的列线图。模型在训练集、内部测试集和外部测试集的AUC分别为0.779、0.789和0.933，有助于术前选择合适的手术策略。
要点
- 超声特征血管化、与甲状腺被膜关系及临床因素年龄、多灶性是侧颈淋巴结转移的独立危险因素。
- 列线图在外部测试集AUC达0.933，区分度良好，可辅助术前评估侧颈淋巴结转移风险。
- 该工具可能帮助临床医生为儿童及青少年甲状腺乳头状癌患者选择合适的手术策略。
核心结论
- 基于临床和超声特征构建的列线图可有效术前预测儿童及青少年甲状腺乳头状癌患者的侧颈淋巴结转移。
研究设计与样本
- 多中心回顾性研究，纳入2013年1月至2025年3月三家医疗中心共300例接受甲状腺全切或部分切除的儿童及青少年甲状腺乳头状癌患者。
- 受试者分为训练集177例、内部测试集75例和外部测试集48例。
- 采用多变量逻辑回归模型构建整合临床和超声特征的列线图，并从区分度、校准度和临床实用性方面进行评估。
诊断标准与关键数值
- 多变量逻辑回归显示血管化、与甲状腺被膜的关系、年龄和多灶性是训练集中预测侧颈淋巴结转移的独立危险因素。
- 列线图预测侧颈淋巴结转移的AUC在训练集为0.779（95%CI 0.711-0.847），内部测试集为0.789（95%CI 0.678-0.899），外部测试集为0.933（95%CI 0.865-1.000）。
临床应用与阅片要点
- 术前超声评估应关注肿瘤血管化程度、与甲状腺被膜的关系及多灶性，结合年龄计算列线图风险以辅助手术决策。
- 列线图预测侧颈淋巴结转移风险较高的患儿可能需考虑更积极的颈侧区处理策略。
局限性
- 本研究为回顾性设计，外部测试集样本量较小（48例），列线图的泛化能力需进一步前瞻性验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
BACKGROUND: Lateral lymph node metastasis (LLNM) is an independent prognostic factor associated with poor outcomes in pediatric patients with papillary thyroid carcinoma (PTC). This study aims to develop and validate an effective preoperative nomogram that integrates clinical and ultrasound features to predict LLNM in children and adolescents with PTC.
METHODS: This study included 300 pediatric patients diagnosed with PTC who underwent either total or partial thyroidectomy at three medical centers between January 2013 and March 2025. The subjects were divided into three datasets for training, internal testing and external testing. We constructed a comprehensive nomogram that incorporated both clinical and ultrasound features and employed a multivariate logistic regression model to predict LLNM in children and adolescents with PTC. The model was evaluated in terms of discrimination, calibration and clinical utility.
RESULTS: The training, internal testing and external testing datasets comprised 177, 75 and 48 pediatric patients with PTC, respectively. Multivariate logistic regression analysis revealed that vascularization, the relationship to the thyroid capsule, age and multifocality were independent risk factors for predicting LLNM in the training dataset. The predictive nomogram model developed using these variables demonstrated strong performance in estimating the risk of LLNM, with an area under the curve of 0.779 (95% confidence interval [CI], 0.711-0.847) for the nomogram in the training cohort, 0.789 (95% CI, 0.678-0.899) in the internal testing cohort, and 0.933 (95% CI, 0.865-1.000) in the external testing cohort.
CONCLUSION: Our research findings indicate that the newly developed nomogram, which is based on clinical and ultrasound characteristics, effectively predicts LLNM in children and adolescents with PTC preoperatively. This tool may assist clinicians in selecting appropriate surgical strategies.
引用
- Wang X, Li Y, Li J, et al. A Practical Nomogram for Preoperative Prediction of Lateral Lymph Node Metastasis in Children and Adolescent Patients With Papillary Thyroid Carcinoma: A Multicenter Retrospective Study. Ultrasound Med Biol. 2026. PMID: 42120263. doi:10.1016/j.ultrasmedbio.2026.04.003
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。