Development of a nomogram incorporating BRAF-V600E to predict central lymph node metastasis in papillary thyroid carcinoma.

Abstract

Objective: This study aims to identify risk factors associated with central lymph node metastasis (CLNM) in individuals with papillary thyroid carcinoma (PTC) and to develop a predictive nomogram model, thereby offering clinicians a valuable tool for guiding surgical treatment decisions in PTC management.

Methods: Clinical and ultrasound data were collected from 348 patients with PTC who underwent surgical treatment at our hospital between July 2022 and November 2023. The cohort was randomly divided into a training group (n = 243) and a validation group (n = 105 cases). Independent risk factors for CLNM were identified using multivariate logistic regression analysis, which was subsequently used to construct a predictive nomogram. The performance of the model was internally validated, and its predictive accuracy was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and calibration curves.

Results: Among the 348 patients, CLNM was observed in 115 (47.33%) patients in the training group and 48 (45.71%) patients in the validation group. Univariate and multivariate logistic regression analyses revealed that male sex, age under 55 years, nodular anteroposterior diameter of ≥1 cm, BRAF-V600E gene mutation, and tumor capsule invasion were independent risk factors for CLNM in PTC (P < 0.05). The constructed nomogram demonstrated strong predictive capability, with areas under the ROC curve (AUC) of 0.84 (95% CI, 0.78-0.89) for the training group and 0.85 (95% CI, 0.78-0.93) for the validation group.

Conclusion: The nomogram constructed based on ultrasound and BRAF-V600E gene mutation status is a reliable predictive tool for CLNM in patients with PTC, potentially aiding clinicians in the formulation of personalized surgical treatment strategies.