目的

分析甲状腺乳头状癌（PTC）对侧中央区淋巴结（Cont-CLNs）转移的危险因素，构建Cont-CLNs转移的预测模型，为PTC淋巴结清扫范围提供参考。

方法

回顾性选取116例接受甲状腺全切+双侧中央区淋巴结（CLNs）清扫术的PTC患者临床及超声资料。根据术后病理结果分为Cont-CLNs转移组和非转移组。数据分析采用SPSS 20.0软件处理，计数资料以［例（%）］表示，行χ²检验；二元Logistic回归分析Cont-CLNs转移的独立风险因素；构建Cont-CLNs转移的预测模型，采用ROC曲线、校准曲线及Hosmer-Lemeshow拟合优度检验评估该模型的诊断效能。P＜0.05差异有统计学意义。

结果

116例PTC患者中有31例（26.7%）发生Cont-CLNs转移。Logistic回归分析显示，性别、肿瘤大小、包膜侵犯、患侧CLNs转移、颈中线淋巴结转移及微钙化是影响Cont-CLNs发生转移的独立风险因素（均P＜0.05）。构建Cont-CLNs转移的回归预测模型，显示该模型预测Cont-CLNs转移的AUC值为0.816（0.697-0.902），拟合优度良好，预测值与实际值具有良好的一致性。

结论

男性、肿瘤≥2cm及发生包膜侵犯、患侧CLNs转移、颈中线淋巴结转移、微钙化是PTC患者发生Cont-CLNs转移的危险因素。

Objective

To analyze the risk factors for contralateral central lymph node （Cont-CLNs）metastasis in papillary thyroid carcinoma （PTC），construct a prediction model for Cont-CLNs metastasis，and provide a reference for the scope of lymph node dissection in PTC.

Methods

The clinical and ultrasound data of 116 PTC patients who underwent total thyroidectomy + bilateral central lymph node （CLNs） dissection were retrospectively selected.According to the postoperative pathological results，they were divided into the Cont-CLNs metastasis group and the non-metastasis group.The data were analyzed using SPSS 20.0 software.The counting data were expressed as ［cases （%）］ and the chi-square test was performed.Binary logistic regression was used to analyze the independent risk factors for Cont-CLNs metastasis.A prediction model for Cont-CLNs metastasis was constructed，and the receiver operating characteristic （ROC） curve，calibration curve，and Hosmer-Lemeshow goodness-of-fit test were used to evaluate the diagnostic efficacy of the model.A P value less than 0.05 was considered statistically significant.

Results

Among 116 PTC patients，31 cases （26.7%）had Cont-CLNs metastasis.Logistic regression analysis showed that gender，tumor size，capsular invasion，CLNs metastasis on the affected side，lymph node metastasis at the midline of the neck，and microcalcification were independent risk factors affecting Cont-CLNs metastasis （all P＜0.05）.A regression prediction model for Cont-CLNs metastasis was constructed，and it was shown that the area under the curve （AUC） value of this model for predicting Cont-CLNs metastasis was 0.816 （0.697-0.902），with good goodness-of-fit，and there was a good consistency between the predicted values and the actual values.

Conclusion

Male gender，tumor size≥2cm，capsular invasion，CLNs metastasis on the affected side，lymph node metastasis at the midline of the neck，and microcalcification are risk factors for Cont-CLNs metastasis in PTC patients.