<b>Prediction of the recurrence of differentiated thyroid carcinoma by post-operative neutrophil and platelet count</b>

Objective: The present study aimed to combine pre- and post-operative peripheral blood laboratory indicators with clinicopathological characteristics to predict differentiated thyroid carcinoma (DTC) recurrence. Study Design: Retrospective case-control analysis.Methods: From June 2013 to December 2020, 488 patients with DTC received treatment at The Second Affiliated Hospital of Guangxi University of Science and Technology. Pre- and post-operative inflammatory marker levels and clinicopathological features were obtained from the medical record system. Kaplan–Meier survival analysis and proportional hazards model were used to assess the DTC recurrence risk. The nomogram was developed to estimate the predictive power of the indicators by the C-index, area under the curve (AUC) and calibration curves. Results: 36 (7.38%) of 488 DTC patients suffered recurrence. Lymph node metastases (LNMs) (hazard ratio [HR]=12.07, 95%CI: 1.82–79.97, P=0.010), tumor diameter ≥2 cm (HR=3.78, 95%CI:1.55-9.25, P=0.004), post-operative neutrophil count (post-NEU)&gt;4.78 109/L (HR=0.29, 95%CI:0.11-0.73, P=0.008), and post-operative platelets count (post-PLT)&gt;316 109/L(HR=2.82, 95%CI:1.37-5.81, P=0.005) were independent risk factors for DTC recurrence. The median AUC values for predicting the recurrence of DTC at 2 years and 3 years were 0.86 (range: 0.75-0.97) and 0.84 (0.72-0.95), respectively. Patients with higher risk in nomogram had lower Recurrence-free survival (RFS) rate at both 2 years and 3 years (all P&lt;0.001). Conclusion: In the present study, DTC patients with LNMs, tumor diameter ≥2 cm, higher post-NEU level, and higher post-PLT level exhibited an increased risk of DTC recurrence. The prediction model incorporating these characteristics robust thereby offering valuable insights into the prognostication of DTC patients in practical healthcare applications.研究目的：本研究旨在将术前及术后外周血液实验室指标与临床病理特征相结合，以预测分化型甲状腺癌（differentiated thyroid carcinoma, DTC）的复发风险。 研究设计：回顾性病例对照分析。 研究方法：2013年6月至2020年12月，广西科技大学第二附属医院收治的488例分化型甲状腺癌患者纳入本研究。从医院电子病历系统中提取患者术前及术后炎症标志物水平与临床病理特征。采用卡普兰-迈耶（Kaplan–Meier）生存分析与比例风险模型评估分化型甲状腺癌的复发风险。通过C指数（C-index）、曲线下面积（area under the curve, AUC）及校准曲线构建列线图（nomogram），以量化评估上述指标的预测效能。 研究结果：488例分化型甲状腺癌患者中，36例（7.38%）出现疾病复发。淋巴结转移（lymph node metastases, LNMs）（风险比（hazard ratio, HR）=12.07，95%置信区间（95% confidence interval, 95%CI）：1.82~79.97，P=0.010）、肿瘤直径≥2 cm（HR=3.78，95%CI：1.55~9.25，P=0.004）、术后中性粒细胞计数（post-NEU）>4.78×10^9/L（HR=0.29，95%CI：0.11~0.73，P=0.008）以及术后血小板计数（post-PLT）>316×10^9/L（HR=2.82，95%CI：1.37~5.81，P=0.005）均为分化型甲状腺癌复发的独立危险因素。本列线图预测分化型甲状腺癌2年、3年复发风险的曲线下面积中位数分别为0.86（范围：0.75~0.97）与0.84（范围：0.72~0.95）。列线图风险评分较高的患者，其2年及3年无复发生存期（recurrence-free survival, RFS）率均显著更低（均P<0.001）。 研究结论：本研究结果显示，伴淋巴结转移、肿瘤直径≥2 cm、术后中性粒细胞水平升高及术后血小板水平升高的分化型甲状腺癌患者，其疾病复发风险显著升高。整合上述临床与实验室特征的预测模型具有稳定可靠的预测效能，可为临床医疗实践中分化型甲状腺癌患者的预后评估提供重要参考依据。