数据大发掘丨淋巴结转移亦许并不影响甲状腺癌病人的存活
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">甲状腺癌是最<span style="color: black;">平常</span>的内分泌腺恶性肿瘤之一。资料<span style="color: black;">表示</span>，自1975年<span style="color: black;">败兴</span>，甲状腺癌的发病率<span style="color: black;">增多</span>了两倍。而乳头状甲状腺癌（PTC），占所有甲状腺恶性肿瘤的80-90％。经典乳头状甲状腺癌和滤泡变异乳头状甲状腺癌（FVPTC）是两种最<span style="color: black;">平常</span>的甲状腺乳头状癌。滤泡变异乳头状甲状腺癌占乳头状甲状腺癌病例的比例高达41％。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">状腺癌<span style="color: black;">病人</span>的预后取决于<span style="color: black;">非常多</span><span style="color: black;">原因</span>，<span style="color: black;">包含</span>年龄、性别、肿瘤<span style="color: black;">体积</span>、类型、局部浸袭程度、远处转移等。<span style="color: black;">因为</span>淋巴结转移可能是甲状腺癌复发的有效预测因子，<span style="color: black;">因此呢</span><span style="color: black;">评定</span>甲状腺癌<span style="color: black;">病人</span>的淋巴结转移<span style="color: black;">状况</span><span style="color: black;">亦</span>非常<span style="color: black;">要紧</span>。但<span style="color: black;">咱们</span><span style="color: black;">发掘</span>很少有淋巴结转移与甲状腺癌预后的<span style="color: black;">关联</span>性数据。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">近期</span>，TMR Publishing Group 旗下的数据挖掘期刊Medical Data Mining 在其<span style="color: black;">网</span>上刊载了一篇西安交通大学医学院<span style="color: black;">第1</span><span style="color: black;">附庸</span>医院临床<span style="color: black;">科研</span>中心吕军教授团队的最新<span style="color: black;">科研</span>成果，其团队<span style="color: black;">经过</span>运用多种数据分析<span style="color: black;">办法</span>，分析了2004年至2014年SEER数据库中的1418名FVPTC<span style="color: black;">病人</span>的<span style="color: black;">存活</span>与淋巴结转移（LNM）的关系。经<span style="color: black;">太多</span>变量模型校正后，基本<span style="color: black;">能够</span>初步认定，年龄，多灶性和放射治疗与<span style="color: black;">疾患</span>特异性死亡率密切<span style="color: black;">关联</span>，淋巴结转移<span style="color: black;">不可</span>独立预测<span style="color: black;">疾患</span>特异性死亡率（p = 0.271）。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">在这项<span style="color: black;">科研</span>中，该团队收集了2004 - 2014年从SEER数据库<span style="color: black;">得到</span>的1,418个案例。进一步的多变量logistic回归分析<span style="color: black;">表示</span>年龄，女性，已婚，放射治疗，肿瘤<span style="color: black;">体积</span>> 4cm和甲状腺外扩散，是LNM的预测因子。年龄是LNM的<span style="color: black;">守护</span><span style="color: black;">原因</span>，这可能与发病年龄较低的甲状腺癌的相对高度恶性程度<span style="color: black;">相关</span>。放射治疗<span style="color: black;">亦</span>是LNM的<span style="color: black;">守护</span><span style="color: black;">原因</span>，提示放射治疗在降低LNM<span style="color: black;">出现</span>率方面<span style="color: black;">拥有</span><span style="color: black;">要紧</span><span style="color: black;">功效</span>。<span style="color: black;">另外</span>，女性和已婚人士<span style="color: black;">亦</span>是LNM的<span style="color: black;">守护</span><span style="color: black;">原因</span>。然而，肿瘤<span style="color: black;">体积</span>> 4cm和甲状腺外扩散是LNM的危险<span style="color: black;">原因</span>，尤其是甲状腺外扩散是最强的预测因子。结果可能提示FVPTC肿瘤> 4cm且甲状腺外扩散的<span style="color: black;">病人</span>应<span style="color: black;">重视</span>淋巴结清扫的彻底性。<span style="color: black;">认识</span>与LNM<span style="color: black;">关联</span>的这些<span style="color: black;">原因</span>有助于<span style="color: black;">咱们</span>进一步分析LNM与<span style="color: black;">疾患</span>特异性死亡率之间的关系。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">进一步的多变量Cox回归分析<span style="color: black;">表示</span>年龄，多灶性和放射治疗可能是<span style="color: black;">疾患</span>特异性死亡的<span style="color: black;">要紧</span><span style="color: black;">危害</span><span style="color: black;">原因</span>。结果<span style="color: black;">显示</span>，老年FVPTC<span style="color: black;">病人</span>的死亡<span style="color: black;">危害</span><span style="color: black;">增多</span>。加强甲状腺癌<span style="color: black;">病人</span>的<span style="color: black;">初期</span>诊断和治疗是<span style="color: black;">保证</span><span style="color: black;">病人</span>安全的<span style="color: black;">重要</span>。虽然放射治疗<span style="color: black;">能够</span>降低淋巴结转移和根除正常甲状腺残余的可能性，但它<span style="color: black;">亦</span>可能诱发其他症状，如泪腺和唾液腺毒性。女性是<span style="color: black;">疾患</span>特异性死亡的<span style="color: black;">守护</span><span style="color: black;">原因</span>。然而，在多变量分析中，LNM未独立预测<span style="color: black;">疾患</span>特异性死亡率。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">为了使结果更加保守，该团队进一步<span style="color: black;">运用</span>Kaplan-Meier<span style="color: black;">存活</span>分析和Log rank检验<span style="color: black;">办法</span>来确定LNM<span style="color: black;">可否</span>会影响FVPTC<span style="color: black;">病人</span>的<span style="color: black;">存活</span>。结果相同：LNM不影响FVPTC的存活（对数秩检验：p = 0.235）</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">因此呢</span>，<span style="color: black;">咱们</span>在现有<span style="color: black;">科研</span>的<span style="color: black;">基本</span>上初步得出的结论是，LNM可能不会影响<span style="color: black;">疾患</span>特异性死亡率。我们<span style="color: black;">发掘</span>两条曲线在Kaplan-Meier<span style="color: black;">存活</span>分析中交叉，Log rank检验p> 0.05，这进一步支持了<span style="color: black;">咱们</span>的结论。</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">该<span style="color: black;">科研</span>中SEER数据库存在<span style="color: black;">必定</span>缺陷，但它仍然<span style="color: black;">供给</span>了用于<span style="color: black;">科研</span>的良好数据。<span style="color: black;">因为</span>本<span style="color: black;">科研</span>采用回顾性设计，只能<span style="color: black;">供给</span><span style="color: black;">关联</span><span style="color: black;">疾患</span>的线索，<span style="color: black;">不可</span>证实LNM与<span style="color: black;">疾患</span>特异性死亡率之间的因果关系。<span style="color: black;">因此呢</span>，<span style="color: black;">咱们</span>的结论还有待进一步的<span style="color: black;">科研</span>。但在设计<span style="color: black;">将来</span>的临床<span style="color: black;">实验</span>时，这些数据可能会对<span style="color: black;">大众</span>有所<span style="color: black;">帮忙</span>。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Cite this article:</p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">Jin Yang, Qing-Qing Liu, Hai-Rong He, Hai-Sheng You, Zhen-Yu Pan, Jun Lyu,. Reanalysis of Lymph node metastasis as predictor of the survival of patients with follicular variant papillary thyroid carcinoma：From SEER database 2004-2014. Medical Data Mining, 2019, 2(1): 1-9</p>
<div style="color: black; text-align: left; margin-bottom: 10px;"><img src="https://pic3.zhimg.com/80/v2-3804139807de9a4d548d79514e675de2_720w.webp" style="width: 50%; margin-bottom: 20px;"></div>
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