Establishment and analysis of a risk factor model for lateral cervical lymph node metastasis in medullary thyroid carcinoma
10.3760/cma.j.cn113855-20250704-00348
- VernacularTitle:甲状腺髓样癌颈部淋巴结转移的危险因素模型建立与分析
- Author:
Xiu CHEN
1
;
Heda ZHANG
1
;
Hao ZHANG
1
Author Information
1. 南京医科大学第一附属医院甲状腺外科，南京 210029
- Publication Type:Journal Article
- Keywords:
Medullary thyroid cancer;
Lymphatic metastasis;
Calcitonin;
Carcinoembryonic antigen;
Risk factors
- From:
Chinese Journal of General Surgery
2025;40(10):775-783
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors for cervical lymph node metastasis and lateral cervical lymph node metastasis, and to explore the role of serum calcitonin(Ctn) and carcinoembryonic antigen(CEA) levels in predicting lymph node metastasis in patients of medullary thyroid carcinoma(MTC).Methods:A retrospective analysis was conducted on the clinical data of 82 MTC patients who underwent primary surgery at Jiangsu Provincial People's Hospital from Nov 2016 to Mar 2024. A multivariate Logistic regression model was constructed to evaluate the association between each predictor and the outcome variable by using the least absolute shrinkage and selection operator (LASSO).Results:LASSO Logistic regression analysis showed that male gender ( OR=2.84,95% CI:1.14-2.38, P=0.065)、serum LnCEA( OR=1.64,95% CI:1.13-2.38, P=0.008)、serum LnCtn( OR=1.41,95% CI:1.01-1.97, P=0.043) were independent influencing factors for cervical lymph node metastasis in MTC. Based on the LASSO-built Logistic regression model, the model had the highest predictive value when female gender, serum CEA≈15.03 ng/ml, serum Ctn≈41.6 pg/ml. The predictive sensitivity was 0.727 (95% CI: 0.618-0.836), specificity was 0.852 (95% CI: 0.704-0.963). Further subgroup analysis for lateral cervical lymph node metastasis showed that in the LASSO-built logistic regression model, when serum CEA≈16.1 ng/ml, and central lymph node metastasis was negative, the predicted sensitivity and specificity were 0.810 and 0.700, respectively. Prognostic analysis revealed that age, Ctn and thyroid stimulating hormone were the influencing factors of the prognosis of MTC. Conclusions:When male gender, serum CEA>15.03 ng/ml and serum Ctn>41.6 pg/ml are met simultaneously in MTC patients, the possibility of cervical lymph node metastasis is the greatest. It is recommended to perform preventive lateral cervical lymph node dissection for MTC patients who has CEA>16.1 ng/ml and LN1a positive at the same time.
