Abstract:

Objective　To explore the factors influencing secondary hypothyroidism in patients with differentiated thyroid cancer after secondary surgery, and to develop a risk prediction model to guide clinical practice. Methods　One hundred and twenty patients who underwent secondary thyroid surgery at Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from January 2022 to January 2024 were selected for the retrospective study. According to whether they had secondary hypothyroidism after the surgery, the patients were divided into a hypothyroidism group (43 cases) and a non-hypothyroidism group (77 cases). The ages, genders, surgical types, lesion location and nature, clinical stages, and lymph node dissection were compared between the two groups. The multivariate logistic regression analysis was used to identify the risk factors of hypothyroidism. A risk prediction model was developed using the R software; its sensitivity and specificity were evaluated by the receiver operating characteristic curve (ROC), and was validated through 1 000 Bootstrap sampling. t and χ² tests were used for the statistical analysis. Results　There were statistical differences in age, gender, lesion location and nature, surgical type, lymph node dissection, and family history of thyroid disease between the two groups (all P<0.05). The multivariate logistic regression analysis showed that older age, female, bilateral lesions, malignant tumor, total thyroidectomy, and family history of thyroid disease were the risk factors of hypothyroidism. The ROC revealed that the area under the curve of the this model was 0.941, with a sensitivity of 95.3% and a specificity of 77.9%. The Bootstrap validation confirmed the model's accuracy, with a mean absolute error of 0.037. Conclusion　The construction of a risk prediction model for secondary hypothyroidism in patients with differentiated thyroid cancer after secondary surgery is not only feasible but also clinically valuable.

Key words:

Differentiated thyroid cancer, Secondary surgery, Secondary hypothyroidism, Thyroid function, Lymph node metastasis

摘要：

目的　探究分化型甲状腺癌患者在接受二次手术后发生继发性甲状腺功能减退症（甲减）的影响因素，并建立相应的风险预测模型以指导临床实践。方法　选取2022年1月至2024年1月在陕西中医药大学附属医院接受二次甲状腺手术的120例分化型甲状腺癌患者进行回顾性研究。根据患者术后是否发生继发性甲减分为甲减组（43例）和非甲减组（77例）。比较两组年龄、性别、手术类型、病变部位、病变性质、临床分期、淋巴结清扫等临床资料，采用多因素logistic回归分析确定继发性甲减的影响因素。运用R软件构建风险预测模型，并采用受试者操作特征曲线（ROC）分析该模型的灵敏度和特异度。使用Bootstrap方法进行1 000次重复采样以验证该模型的预测效能。采用t检验、χ²检验进行统计分析。结果　甲减组与非甲减组年龄、性别、病变部位、病变性质、手术类型、淋巴结清扫情况、甲状腺疾病家族史等比较，差异均有统计学意义（均P<0.05）。多因素logistic回归分析显示，年龄较大、女性、双侧病变、恶性肿瘤、甲状腺全切除术、有甲状腺疾病家族史是继发性甲减的危险因素（均P<0.05）。基于这些指标构建的风险预测模型的ROC显示，模型预测继发性甲减风险的曲线下面积为0.941，灵敏度为95.3%，特异度为77.9%，表明该模型具有较好的区分能力。Bootstrap验证表明，该模型的偏差校准曲线与理想曲线吻合良好，均方误差为0.037。结论　通过分析年龄、性别、病理类型、淋巴结转移情况、手术类型等情况来构建分化型甲状腺癌患者二次手术后继发性甲减风险的预测模型是可行的，对临床实践具有指导意义。

关键词:

分化型甲状腺癌, 二次手术, 继发性甲减, 甲状腺功能, 淋巴结转移