[1]郭佩欣,计宏媛,刘志,等.基于超声图像特征对甲状腺乳头状癌喉返神经侵犯的危险因素分析[J].中国医学物理学杂志,2025,42(9):1153-1158.[doi:DOI:10.3969/j.issn.1005-202X.2025.09.005]
　GUO Peixin,JI Hongyuan,LIU Zhi,et al.Risk factor analysis of recurrent laryngeal nerve invasion in papillary thyroid carcinoma based on ultrasound image characteristics[J].Chinese Journal of Medical Physics,2025,42(9):1153-1158.[doi:DOI:10.3969/j.issn.1005-202X.2025.09.005]
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基于超声图像特征对甲状腺乳头状癌喉返神经侵犯的危险因素分析()

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

卷:
42
期数:
2025年第9期
页码:
1153-1158
栏目:
医学影像物理
出版日期:
2025-09-30

文章信息/Info

Title:
Risk factor analysis of recurrent laryngeal nerve invasion in papillary thyroid carcinoma based on ultrasound image characteristics
文章编号:
1005-202X（2025）09-1153-06
作者:
郭佩欣1; 计宏媛1; 刘志2; 何超颖1
1.广州医科大学附属中医医院超声医学科， 广东 广州 510130； 2.南方医科大学南方医院超声诊断科， 广东 广州 510515
Author(s):
GUO Peixin1;  JI Hongyuan1;  LIU Zhi2;  HE Chaoying1
1. Department of Ultrasound Medicine, the Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou 510130, China 2. Department of Ultrasound Diagnosis, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
关键词:
甲状腺乳头状癌; 喉返神经侵犯; 超声图像; 危险因素; 回归方程; 预测价值
Keywords:
Keywords: papillary thyroid carcinoma recurrent laryngeal nerve invasion ultrasound image risk factor regression equation predictive value
分类号:
R318；R445.1
DOI:
DOI:10.3969/j.issn.1005-202X.2025.09.005
文献标志码:
A
摘要:
目的：基于超声图像特征探讨甲状腺乳头状癌（PTC）患者喉返神经（RLN）侵犯的危险因素，并构建回归方程，探索其预测价值，为临床防治PTC患者发生RLN侵犯提供参考。方法：回顾性分析2020年1月~2024年11月广州医科大学附属中医医院及南方医科大学南方医院经病理确诊的1 195例PTC患者的临床资料，根据所选患者是否发生RLN侵犯将其分为侵犯组（n=28）和未侵犯组（n=1 167）。比较两组患者临床、病理资料及超声图像特征，予以多因素Logistic回归分析PTC患者发生RLN侵犯的危险因素，并构建回归方程，似然比[χ2]进行评估，Hosmer-Lemeshow检验拟合度，绘制受试者工作特征曲线（ROC）分析回归方程对PTC患者发生RLN侵犯的预测价值，获取曲线下面积（AUC）。结果：侵犯组肿瘤矢状位置为后部、肿瘤最大径≥1 cm、接触被膜及有淋巴结转移占比高于未侵犯组（P<0.05）。多因素Logistic回归分析显示，肿瘤矢状位置为后部（OR=1.079，95%CI：1.031~1.129）、肿瘤最大径≥1 cm（OR=2.408，95%CI：1.256~4.617）、接触被膜（OR=3.171，95%CI:1.724~5.833）及有淋巴结转移（OR=3.425，95%CI:1.884~6.226）均是PTC患者发生RLN侵犯的独立危险因素（P<0.05）。构建回归方程：logit（P）=-8.552+肿瘤矢状位置为后部×0.076+肿瘤最大径≥1 cm×0.879+接触被膜×1.154+有淋巴结转移×1.231。似然比[χ2]评估回归方程，提示回归方程构建有效（P<0.001）。Hosmer-Lemeshow检验回归方程拟合度，提示回归方程拟合效果较好（P>0.05）。ROC曲线分析显示，当logit（P）>0.875时，AUC值为0.901，95%CI为0.882~0.917，敏感度为75.00%，特异度为88.95%。结论：PTC患者发生RLN侵犯与肿瘤矢状位置为后部、肿瘤最大径≥1 cm、接触被膜及有淋巴结转移有关，据此构建的回归方程能较好地预测PTC患者RLN侵犯的发生，有望为临床工作提供有效的指导。
Abstract:
Abstract: Objective To explore the risk factors for recurrent laryngeal nerve (RLN) invasion in patients with papillary thyroid carcinoma (PTC) based on ultrasound image characteristics, construct a regression equation, and explore its predictive value for providing a reference for the clinical prevention and treatment of RLN invasion in PTC patients. Methods A retrospective analysis was conducted on 1 195 patients who were pathologically diagnosed with PTC in the Affiliated TCM Hospital of Guangzhou Medical University and Nanfang Hospital, Southern Medical University from January 2020 to November 2024. These patients were divided into invasion group (n=28) and non-invasion group (n=1 167) according to whether they had RLN invasion or not. The clinical data, pathological data and ultrasound image characteristics were compared between two groups. The risk factors for RLN invasion in PTC patients were identified using multifactorial Logistic regression to construct a regression equation which was then evaluated using the likelihood ratio [χ2]. Moreover, the Hosmer-Lemeshow test was utilized to assess the goodness of fit, and the receiver operating characteristic (ROC) curve was plotted to analyze the predictive value of the regression equation for RLN invasion in PTC patients, and the area under the curve (AUC) was calculated. Results The proportions of patients with tumor located in the posterior sagittal position, maximum tumor diameter ≥ 1 cm, capsule contact and lymph node metastasis were higher in invasion group than in non-invasion group (P<0.05). Multifactorial Logistic regression analysis identified tumor located in the posterior sagittal position (OR=1.079, 95%CI: 1.031-1.129), maximum tumor diameter ≥ 1 cm (OR=2.408, 95%CI: 1.256-4.617), capsule contact (OR=3.171, 95%CI: 1.724-5.833), and lymph node metastasis (OR=3.425, 95%CI: 1.884-6.226) as independent risk factors for RLN invasion in PTC patients (P<0.05). The regression equation was constructed as followed: logit (P) = -8.552 + tumor located in the posterior sagittal position × 0.076 + maximum tumor diameter ≥ 1 cm × 0.879 + capsule contact×1.154 + lymph node metastasis×1.231. The likelihood ratio [χ2] evaluation of the regression equation suggested that the regression equation was effectively constructed (P<0.001). Hosmer-Lemeshow test for the goodness of fit of the regression equation showed that the regression equation was well fitted (P>0.05). ROC curve analysis revealed that when logit (P) > 0.875, the AUC value was 0.901 (95%CI: 0.882-0.917), with a sensitivity of 75.00% and a specificity of 88.95%. Conclusion The occurrence of RLN invasion in PTC patients is associated with tumor located in the posterior sagittal position, maximum tumor diameter ≥ 1 cm, capsule contact, and lymph node metastasis, and the regression equations constructed based on these factors can well predict the occurrence of RLN invasion in PTC patients and is expected to provide an effective guidance for clinical practice.

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备注/Memo

备注/Memo:
【收稿日期】2025-04-19 【基金项目】国家自然科学基金青年项目（82305176） 【作者简介】郭佩欣，主治医生，研究方向：超声诊断，E-mail: guopx89@163.com
更新日期/Last Update: 2025-09-30