Table_1_Preoperatively Predicting the Central Lymph Node Metastasis for Papillary Thyroid Cancer Patients With Hashimoto’s Thyroiditis.docx

BackgroundThe preoperative distinguishment of lymph nodes with reactive hyperplasia or tumor metastasis plays a pivotal role in guiding the surgical extension for papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT), especially in terms of the central lymph node (CLN) dissection. We aim to identify the preparative risk factors for CLN metastasis in PTC patients concurrent with HT.
Materials and MethodsWe retrospectively reviewed and analyzed the data including the basic information, preoperative sonographic characteristics, and thyroid function of consecutive PTC patients with HT in our medical center between Jan 2019 and Apr 2021. The Chi-square and Fisher’s exact tests were used for comparison of qualitative variables among patients with or without CLN metastasis. Univariate and multivariate logistic regression analyses were used to determine the risk factors for CLN metastasis. The nomogram was constructed and further evaluated by two cohorts produced by 1,000 resampling bootstrap analysis.
ResultsA total of 98 in 214 (45.8%) PTC patients were identified with CLN metastasis. In multivariate analysis, four variables including high serum thyroglobulin antibody (TgAb) level (>1,150 IU/ml), lower tumor location, irregular margin of CLN, and micro-calcification in the CLN were determined to be significantly associated with the CLN metastasis in PTC patients with HT. An individualized nomogram was consequently established with a favorable C-index of 0.815 and verified via two internal validation cohorts.
ConclusionsOur results indicated that preoperatively sonographic characteristics of the tumor and lymph node condition combined with serum TgAb level can significantly predict the CLN in PTC patients with HT and the novel nomogram may further help surgeons to manage the CLN in this subpopulation.

背景 对于合并桥本甲状腺炎（Hashimoto’s thyroiditis, HT）的甲状腺乳头状癌（papillary thyroid carcinoma, PTC）患者，术前区分反应性增生淋巴结与肿瘤转移性淋巴结，对于指导手术切除范围，尤其是中央区淋巴结（central lymph node, CLN）清扫，具有关键作用。本研究旨在明确合并HT的PTC患者发生中央区淋巴结转移的术前危险因素。

材料与方法 回顾性分析2019年1月至2021年4月期间，本医疗中心连续收治的合并HT的PTC患者的临床资料，包括基本信息、术前超声特征及甲状腺功能指标。采用卡方检验与Fisher确切概率法比较有无中央区淋巴结转移患者的定性变量差异。通过单因素与多因素logistic回归分析筛选中央区淋巴结转移的危险因素。构建列线图（nomogram），并通过1000次重抽样bootstrap分析生成的两个队列进行内部验证。

结果 本研究共纳入214例合并HT的PTC患者，其中98例（45.8%）发生中央区淋巴结转移。多因素分析显示，血清甲状腺球蛋白抗体（thyroglobulin antibody, TgAb）高水平（>1150 IU/ml）、肿瘤位置较低、中央区淋巴结边缘不规则、中央区淋巴结内微钙化这4个变量，与合并HT的PTC患者发生中央区淋巴结转移显著相关。据此构建的个体化列线图（nomogram）的一致性指数（C-index）为0.815，经两个内部验证队列验证，表现良好。

结论 本研究结果表明，联合术前肿瘤超声特征、淋巴结状态与血清TgAb水平，可有效预测合并HT的PTC患者的中央区淋巴结转移情况，本研究构建的新型列线图可进一步帮助外科医师针对该亚群患者制定中央区淋巴结清扫策略。