AUTHOR=Song Xiaolong , Skog Sven , Wei Long , Qin Jinlv , Yang Ru , Li Jin , Zhou Ji , He Ellen , Zhou Jianping 

TITLE=Nomogram model of serum thymidine kinase 1 combined with ultrasonography for prediction of central lymph node metastasis risk in patients with papillary thyroid carcinoma pre-surgery

JOURNAL=Frontiers in Endocrinology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2024.1366219

DOI=10.3389/fendo.2024.1366219

ISSN=1664-2392

ABSTRACT=Objective: To develop a nomogram, using serum thymidine kinase 1 protein (STK1p) combined with ultrasonography parameters, to early predict central lymph node metastasis (CLNM) in patients with papillary thyroid carcinoma (PTC) pre-surgery. Methods: A cohort of patients with PTC pre-surgery were divided as observations (CLNM, n=140), controls (NCLNM, n=128) and external verifications (CLNM, n=50；NCLNM, n=50)  in January 2021 to February 2023. STK1p was detected by enzyme immunodot-blot chemiluminescence analyzer and clinical parameters were evaluated by ultrasonography. Results: A suitable risk threshold value for STK1p of 1.7 pmol/L was selected for predicting CLNM risk by receiver operation characteristic (ROC) curve analysis. Multivariate analysis identified six independent risk factors for CLNM as follows: maximum tumor size ≥1 cm (odds ratio (OR) = 2.406, 95% confidence interval (CI) [2.102-7.859], P = 0.006); capsule invasion (OR = 2.664, 95% CI [1.324-5.360], P = 0.006); irregular margin (OR = 2.922; 95% CI [1.397-6.111], P = 0.004); CLN flow signal (OR = 3.618, 95% CI [1.631-8.027], P = 0.002); tumor-foci number ≥2 (OR = 4.064, 95% CI [2.102-7.859], P < 0.001); and STK1p ≥1.7 pmol/L (OR = 7.514, 95% CI [3.852-14.660], P < 0.001). The constructed nomogram showed that the area under the ROC curve for the main dataset was 0.867 and the validation dataset was 0.830, exhibiting an effectively and recalculated to a total score of 383 approximately. With monitoring the response to post-surgery, all patients were assessed as tumor-free at 12 months post-surgery which was significantly associated with a reduction in STK1p to disease-free levels.We demonstrate for the first time that a novel nomogram including STK1p combined with ultrasonography can assist in clinical prevention of CLNM, by facilitating timely, individualized prophylactic CLNM dissection, thereby reducing the risk of secondary surgery and the probability of recurrence.