术前炎症指标预测高危甲状腺乳头状癌术后复发的价值

Predictive value of preoperative inflammatory markers for postoperative recurrence in high-risk papillary thyroid carcinoma

摘要:

背景与目的 高危甲状腺乳头状癌患者术后仍存在较高复发风险，寻找简便、可靠的预后评估指标具有重要临床意义。本研究探讨术前中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）及全身免疫炎症指数（SII）对高危甲状腺乳头状癌患者术后复发的预测价值。方法 回顾性分析2018年1月—2024年12月在河北省唐山市工人医院接受根治性手术治疗的337例高危甲状腺乳头状癌患者临床资料。根据随访结果分为复发组（41例）和未复发组（296例）。比较两组患者临床病理特征及术前炎症指标水平，采用ROC曲线评估各指标预测复发的效能，通过Logistic回归分析复发相关危险因素，并采用Kaplan-Meier法分析无复发生存（RFS）。结果 337例患者中有41例（12.2%）发生复发。与未复发组比较，复发组NLR、PLR及SII水平均明显降低（均P<0.05）。ROC曲线分析显示，NLR、PLR和SII预测术后复发的AUC分别为0.728、0.780和0.823，其中SII预测效能最高。多因素Logistic回归分析显示，PLR≤118.26（OR=5.894，95% CI=1.615~21.508，P=0.007）和SII≤397.56（OR=5.715，95% CI=1.721~18.983，P=0.004）为术后复发的独立危险因素。Kaplan-Meier分析显示，低PLR组和低SII组患者RFS均明显低于相应高值组（均P<0.05）。结论 术前PLR和SII与高危甲状腺乳头状癌患者术后复发密切相关，是预测术后复发的独立危险因素。其中SII具有较好的预测效能，可作为高危甲状腺乳头状癌患者风险分层和预后评估的辅助指标。

Abstract:

Background and Aims Patients with high-risk papillary thyroid carcinoma (PTC) remain at substantial risk of postoperative recurrence. Identification of simple and reliable prognostic biomarkers is therefore of clinical importance. This study aimed to evaluate the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) for postoperative recurrence in patients with high-risk PTC.Methods Clinical data of 337 patients with high-risk PTC who underwent radical surgery at Tangshan Workers' Hospital between January 2018 and December 2024 were retrospectively analyzed. According to follow-up outcomes, patients were divided into recurrence (n=41) and non-recurrence (n=296) groups. Clinicopathological characteristics and preoperative inflammatory indices were compared between groups. Receiver operating characteristic (ROC) curve analysis was performed to evaluate predictive performance. Logistic regression analysis was used to identify independent predictors of recurrence, and recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method.Results During follow-up, 41 patients (12.2%) developed recurrence. Compared with the non-recurrence group, the recurrence group exhibited significantly lower NLR, PLR, and SII levels (all P<0.05). ROC analysis showed that the AUC values of NLR, PLR, and SII for predicting recurrence were 0.728, 0.780, and 0.823, respectively, with SII demonstrating the best predictive performance. Multivariate Logistic regression analysis identified PLR≤118.26 (OR=5.894, 95% CI=1.615-21.508, P=0.007) and SII≤397.56 (OR=5.715, 95% CI=1.721-18.983, P=0.004) as independent risk factors for postoperative recurrence. Kaplan-Meier analysis showed significantly lower RFS rates in patients with low PLR and low SII levels than in those with higher values (both P<0.05).Conclusion Preoperative PLR and SII are independently associated with postoperative recurrence in patients with high-risk PTC. SII exhibits favorable predictive performance and may serve as a useful biomarker for risk stratification and prognostic evaluation in this population.