术前超声联合NLR、Ctn、CEA水平预测甲状腺乳头状癌颈侧区淋巴结转移的价值分析

doi:10.3969/j.issn.1006-5725.2025.18.011

Abstract

Abstract:

Objective To investigate the predictive value of preoperative ultrasound in combination with neutrophil-to-lymphocyte ratio （NLR）， calcitonin （Ctn）， and carcinoembryonic antigen （CEA） for cervical lymph node metastasis in patients with papillary thyroid carcinoma. Methods A total of 103 patients diagnosed with papillary thyroid carcinoma （PTC） who were admitted to the hospital between October 2021 and October 2024 were selected as the case group. Among them， 34 patients with cervical lymph node metastasis confirmed by surgical and pathological examination were assigned to the metastatic group， and 69 patients without cervical lymph node metastasis were assigned to the non-metastatic group. Additionally， 103 patients with benign thyroid nodules admitted during the same period were enrolled as the control group. Clinical data， ultrasonographic features， and serum levels of NLR， Ctn， and CEA were compared between the metastatic and non-metastatic groups. The predictive value of ultrasonographic features and the combined detection of NLR， Ctn， and CEA levels for cervical lymph node metastasis in PTC was evaluated using receiver operating characteristic （ROC） curve analysis. Results Compared to the control group， the case group exhibited a higher proportion of patients with microcalcification and grade 3 blood flow， as well as elevated levels of NLR， Ctn， and CEA （P < 0.05）. Similarly， compared to the non-metastatic group， the metastatic group showed a higher proportion of patients with microcalcification and grade 3 blood flow， along with increased levels of NLR， Ctn， and CEA （P < 0.05）. The metastatic group tested positive， whereas the non-metastatic group tested negative. The area under the curve （AUC） for ultrasound features （microcalcification， blood flow classification） combined with NLR， Ctn， and CEA levels in diagnosing cervical lymph node metastasis in papillary thyroid carcinoma was higher than that of individual indicators （P < 0.05）. Conclusions Preoperative ultrasound combined with the assessment of NLR， Ctn， and CEA levels demonstrates significant predictive value for cervical lymph node metastasis in papillary thyroid carcinoma.

Key words: papillary thyroid carcinoma, cervical lymph node metastasis, ultrasound, neutrophil to lymphocyte ratio, calcitonin, carcinoembryonic antigen

CLC Number:

R736.1

Shanshan YAN,Huiyu ZHANG,Jun GU,Kan ZHANG,Yu ZHAO. Value of preoperative ultrasound combined with NLR， Ctn and CEA levels in predicting cervical lymph node metastasis of papillary thyroid carcinoma[J]. The Journal of Practical Medicine, 2025, 41(18): 2859-2864.

Figures/Tables 5

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References 30

[1]	YANG Z， HENG Y， QIU W， et al. Cervical lymph node metastasis differences in patients with unilateral or bilateral papillary thyroid microcarcinoma： A multi-center analysis［J］. J Clin Med， 2022， 11（16）： 4929-4929. doi:10.3390/jcm11164929 doi: 10.3390/jcm11164929
[2]	MOU Y， HAN X， LI J， et al. Development and validation of a computed tomography-based radiomics nomogram for the preoperative prediction of central lymph node metastasis in papillary thyroid microcarcinoma［J］. Acad Radiol， 2024， 31（5）： 1805-1817. doi:10.1016/j.acra.2023.11.030 doi: 10.1016/j.acra.2023.11.030
[3]	WENLONG W， YING D， YUNZHE Z， et al. m6A reader IGF2BP2 promotes lymphatic metastasis by stabilizing DPP4 in papillary thyroid carcinoma［J］. Cancer Gene Ther， 2023， 31（2）： 285-299. doi:10.1038/s41417-023-00702-2 doi: 10.1038/s41417-023-00702-2
[4]	YUDONG N， YUEBAI L， DINGFEN Z， et al. Patterns of lymph node metastasis in level IIB and contralateral level VI for papillary thyroid carcinoma with pN1b and safety of low collar extended incision for neck dissection in level II［J］. World J Surg Oncol， 2023， 21（1）： 249-249. doi:10.1186/s12957-023-03075-w doi: 10.1186/s12957-023-03075-w
[5]	JING L， XIAOFENG W， WEI W， et al. Conventional ultrasound combined with contrast-enhanced ultrasound predicts lateral lymph node metastasis in papillary thyroid carcinoma［J］. Clin Hemorheol Microcirc， 2025， 89（1）： 83-94.
[6]	ZHAO J， LI M L， GAO L， et al. Prediction model construction of cervical central lymph node metastasis in papillary thyroid carcinoma combined with Hashimoto's thyroiditis utilizing conventional ultrasound and elastography［J］. Gland Surg， 2024， 13（12）： 2325-2334. doi:10.21037/gs-24-271 doi: 10.21037/gs-24-271
[7]	XU N， ZHANG X J， ZHANG J J， et al. The prognostic value of the neutrophil-to-lymphocyte ratio （NLR） and platelet-to-lymphocyte ratio （PLR） in colorectal cancer and colorectal anastomotic leakage patients： A retrospective study［J］. BMC Surg， 2025， 25（1）： 57-57. doi:10.1186/s12893-024-02708-5 doi: 10.1186/s12893-024-02708-5
[8]	PRINZI A， FRASCA F， RUSSO M， et al. Pre-Operative Calcitonin and CEA Values May Predict the Extent of Metastases to the Lateral Neck Lymph Nodes in Patients with Medullary Thyroid Cancer［J］. Cancers， 2024， 16（17）： 2979-2979. doi:10.3390/cancers16172979 doi: 10.3390/cancers16172979
[9]	中华医学会内分泌学分会，中华医学会外科学分会内分泌学组，中国抗癌协会头颈肿瘤专业委员会，等. 甲状腺结节和分化型甲状腺癌诊治指南［J］. 中华核医学与分子影像杂志， 2013， 33（2）： 96-115.
[10]	李惠霖，张波. 超声特征与甲状腺乳头状癌基因突变及病理亚型的相关性［J］. 中国医学科学院学报， 2024， 46（5）： 747-755.
[11]	陈浩浩，刘岩岩，马小鹏，等. 无充气后入路经锁骨下腔镜甲状腺手术治疗甲状腺乳头状癌的学习曲线及短期临床疗效［J］. 中国普通外科杂志， 2024， 33（5）： 848-855.
[12]	QIAOLI L， TING M， ZIJING W， et al. The value of contrast-enhanced ultrasound for the diagnosis of metastatic cervical lymph nodes of papillary thyroid carcinoma： A systematic review and meta-analysis［J］. J Clin Ultrasound， 2021， 50（1）： 60-69. doi:10.1002/jcu.23073 doi: 10.1002/jcu.23073
[13]	ROMENA L， VALENTINAS J， LAIMA A， et al. Dysregulation of microRNAs as the risk factor of lymph node metastasis in papillary thyroid carcinoma： Systematic review［J］. Endokrynol Pol， 2021， 72（2）： 145-152. doi:10.5603/ep.a2021.0010 doi: 10.5603/ep.a2021.0010
[14]	LESZEK H， WOJCIECH D. Incidental detection of unexpected neck lymphatic III level node metastasis from occult papillary thyroid carcinoma during cervical disc surgery： First literature report［J］. Endokrynol Pol， 2020， 71（4）： 361-362.
[15]	WANG Y， SI Y， WU J， et al. Preoperative ultrasound-guided injection of nanocarbon for central lymph node dissection in patients with papillary thyroid carcinoma［J］. Sci Rep， 2024， 14（1）： 29185-29185. doi:10.1038/s41598-024-80364-8 doi: 10.1038/s41598-024-80364-8
[16]	LIN S， ZHONG Y， LIN Y， et al. Prediction model for lateral lymph node metastasis of papillary thyroid carcinoma in children and adolescents based on ultrasound imaging and clinical features： A retrospective study［J］. BMC Med Imaging， 2024， 24（1）： 228-228. doi:10.1186/s12880-024-01384-4 doi: 10.1186/s12880-024-01384-4
[17]	FU J， LIU J， WANG Z， et al. Predictive Values of Clinical Features and Multimodal Ultrasound for Central Lymph Node Metastases in Papillary Thyroid Carcinoma［J］. Diagnostics， 2024， 14（16）： 1770-1770. doi:10.3390/diagnostics14161770 doi: 10.3390/diagnostics14161770
[18]	SALARI A， GHAHARI M， BITARAF M， et al. Prognostic Value of NLR， PLR， SII， and dNLR in Urothelial Bladder Cancer Following Radical Cystectomy［J］. Clin Genitourin Cancer， 2024， 22（5）： 102144-102144. doi:10.1016/j.clgc.2024.102144 doi: 10.1016/j.clgc.2024.102144
[19]	XING H， YUAN D， ZHU Y， et al. A nomogram model based on SII， AFR， and NLR to predict infectious complications of laparoscopic hysterectomy for cervical cancer［J］. World J Surg Oncol， 2024， 22（1）： 190-190. doi:10.1186/s12957-024-03489-0 doi: 10.1186/s12957-024-03489-0
[20]	JIAWEI L， RUIZHENG S， KAIMEI C， et al. A nomogram combining neutrophil to lymphocyte ratio （NLR） and prognostic nutritional index （PNI） to predict distant metastasis in gastric cancer［J］. Sci Rep， 2024， 14（1）： 15391-15391. doi:10.1038/s41598-024-65307-7 doi: 10.1038/s41598-024-65307-7
[21]	赵顺顺，张敏，程若川，等. 血清降钙素在甲状腺髓样癌诊治中应用研究进展［J］. 中国实用外科杂志， 2023， 43（8）： 946-950.
[22]	先柯瑶，刘杰. 基于降钙素水平的甲状腺髓样癌手术范围的研究进展与争议［J］. 中华医学杂志， 2024， 104（20）： 1755-1758.
[23]	张灵羽，付利军，孙宁，等. 血清proGRP、Ctn、CEA在甲状腺髓样癌鉴别诊断和预测颈侧区淋巴结转移中的价值［J］. 郑州大学学报（医学版）， 2022， 57（2）： 271-275.
[24]	闫闻晓，黄春旺，尚诗瑶，等. 术前超声联合降钙素水平预测甲状腺髓样癌颈侧区淋巴结转移［J］. 中国医学影像技术， 2022， 38（3）： 353-357.
[25]	ASHI A， HAJEILI A M， ALMAGHRABI S， et al. Prevalence of CEA， CA 125， and CA 15-3 serum tumour markers in different regions of Saudi Arabia［J］. Saudi Med J， 2024， 45（6）： 565-571. doi:10.15537/smj.2024.45.6.20230878 doi: 10.15537/smj.2024.45.6.20230878
[26]	DAVID S， LUDIVINE B， ANDRÉ G， et al. CEA， CA19-9， circulating DNA and circulating tumour cell kinetics in patients treated for metastatic colorectal cancer （mCRC）［J］. Br J Cancer， 2021， 125（5）： 725-733. doi:10.1038/s41416-021-01431-9 doi: 10.1038/s41416-021-01431-9
[27]	YOUNGKI H， AMANDEEP G， SEONG K P， et al. Can Normalized Carcinoembryonic Antigen （CEA） following Neoadjuvant Chemoradiation Predict Tumour Recurrence after Curative Resection for Locally Advanced Rectal Cancer？［J］. Colorectal Dis， 2021， 23（6）： 1346-1356. doi:10.1111/codi.15583 doi: 10.1111/codi.15583
[28]	LUAN F， XU S， CHEN K， et al. Prognostic effect of CEA， AFP， CA19‑9 and CA242 for recurrence/metastasis of gastric cancer following radical gastrectomy［J］. Mol Clin Oncol， 2025， 22（2）： 17-17. doi:10.3892/mco.2024.2812 doi: 10.3892/mco.2024.2812
[29]	KAVGACI G， SAHIN K T， MUDERRISOGLU T， et al. Post-operative serum CEA predicts prognosis in hr-positive/HER2-negative early breast cancer［J］. Expert Rev Anticancer Ther， 2024， 24（12）： 1319-1326. doi:10.1080/14737140.2024.2443009 doi: 10.1080/14737140.2024.2443009
[30]	HADDAD A， LENDOIRE M， UPPAL A， et al. CEA Rebound After Discontinuation of Pre-Hepatectomy Chemotherapy Predicts Worse Outcomes After Resection of Colorectal Cancer Liver Metastases［J］. Ann Surg Oncol， 2024， 32（2）： 1-12. doi:10.1245/s10434-024-16370-x doi: 10.1245/s10434-024-16370-x

指标	对照组（n = 103）	病例组（n = 103例）	t/χ² /Z值	P值
结节最大径（x ± s）/mm	9.87 ± 1.85	9.62 ± 1.91	0.954	0.341
微钙化	13（12.62）	43（41.75）	22.071	< 0.001
囊变	5（4.85）	7（6.80）	0.354	0.552
血流			9.131	< 0.001
0 ~ 1级	62（60.19）	13（12.62）
2级	41（39.81）	34（33.01）
3级	0（0.00）	56（54.37）
NLR（x ± s）	1.59 ± 0.32	2.01 ± 0.45	7.720	< 0.001
Ctn（x ± s）/（ng/L）	10.65 ± 1.42	285.45 ± 12.56	220.642	< 0.001
CEA（x ± s）/（μg/L）	2.14 ± 0.45	5.54 ± 0.58	47.005	< 0.001

指标	未转移组（n = 69）	转移组（n = 34）	t/χ² /Z值	P值
结节最大径（x ± s）/mm	9.56 ± 1.23	9.75 ± 1.44	0.696	0.488
微钙化	23（33.33）	20（58.82）	6.085	0.014
囊变	3（4.35）	4（11.76）	1.978	0.160
血流			3.239	0.001
0 ~ 1级	10（14.49）	3（8.82）
2级	30（43.48）	4（11.76）
3级	29（42.03）	27（79.41）
NLR（x ± s）	1.84 ± 0.32	2.35 ± 0.43	6.767	< 0.001
Ctn（x ± s）/（ng/L）	280.09 ± 11.54	296.33 ± 11.84	6.659	< 0.001
CEA（x ± s）/（μg/L）	5.14 ± 0.48	6.35 ± 0.55	11.459	< 0.001

指标	截断值	AUC	敏感度/%	特异度/%	P值	95%CI
微钙化	-	0.627	58.82	66.67	< 0.001	0.527 ~ 0.721
血流分级	-	0.687	79.41	57.97	< 0.001	0.588 ~ 0.775
NLR	2.25	0.720	64.71	72.46	< 0.001	0.623 ~ 0.804
Ctn	286.69 ng/L	0.768	82.35	60.87	< 0.001	0.674 ~ 0.845
CEA	6.16 μg/L	0.725	61.76	78.26	< 0.001	0.628 ~ 0.808
联合检测	-	0.948^?△▲#	82.35	95.65	< 0.001	0.885 ~ 0.982

Value of preoperative ultrasound combined with NLR， Ctn and CEA levels in predicting cervical lymph node metastasis of papillary thyroid carcinoma

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