| Objective:Many inflammatory cells and soluble cellular inflammatory mediators are involved in the initiation and progression of cancer.In response,peripheral blood inflammatory markers have now shown relevance in a variety of solid tumors.The correlation between papillary thyroid cancer and inflammatory markers still lacks large-scale clinical studies.Based on the background,the aim of this study was to explore the value of inflammatory markers represented by neutrophil to lymphocyte ratio（NLR）,platelet to lymphocyte ratio（PLR）and system immune inflammation index（SII）in the risk assessment of thyroid nodules.Methods:This study retrospectively analyzed the case data of 616 patients with thyroid nodules who attended the Department of Thyroid Surgery at the First Hospital of Jilin University from January 2020 to January 2021,and all cases were strictly screened and met the inclusion criteria.The 616 patients were divided into benign and malignant groups based on surgical pathology results or puncture cytology and molecular biology tests.Patient data collected included: gender,age,height,weight,TSH,FT3,FT4,Tgab,Tpoab,neck ultrasound TI-RADS grading,and whether combined Hashimoto’s thyroiditis.In addition to the above basic data,the data of patients in the malignant group also included: size of cancer foci,multifocality,whether it was bilateral,whether it invaded the peritoneum,whether it was accompanied by lymph node metastasis in the central region,whether it was accompanied by lateral neck lymph node metastasis,and whether it was accompanied by Hashimoto’s thyroiditis.All the collected data were imported into SPSS22.0 for data analysis.The data were compared between the benign and malignant groups,and binary logistic regression analysis was used to derive independent risk factors for papillary thyroid cancer and to evaluate the efficacy of the regression model test.The area under curve（AUC）of NLR,PLR,SII and the combination of different inflammatory markers was calculated by plotting the receiver operating characteristic curve（ROC）and comparing the effectiveness of individual and combined markers for the diagnosis of benign and malignant thyroid nodules.The best cut-off values were obtained by comparing the efficacy of individual and combined markers for the diagnosis of benign and malignant thyroid nodules.The malignant groups were divided into high NLR and low NLR groups,high PLR and low PLR groups,and high SII and low SII groups according to the magnitude of the best cut-off values of NLR,PLR,and SII,respectively,to explore the effects of NLR,PLR,and SII on the clinicopathological factors of PTC patients.Results:Among the 616 patients with thyroid nodules,there were 204 benign nodules and412 malignant nodules.Male patients were 122（19.8%）and female patients were 494（80.2%）,of whom 157（25.5%）were 55 years old or older and 459（74.5%）were under 55 years old.The median BMI was 24.27（22.23,26.94）Kg/㎡.The median NLR was 1.92（1.46,2.52）.The median PLR was 134.87（107.80,166.85）.and the median SII was 473.52（345.00,622.43）.The median values of each of the five indicators of thyroid function were: TSH: 1.75（1.15,2.51）μIU/m L,FT3: 4.73（4.31,5.21）pmol/L,FT4: 13.27（12.15,14.65）pmol/L,Tgab: 2.42（1.00,14.37）IU/m L,and Tpoab: 0.90（0.40,18.78）IU/m L.In the TI-RADS classification of thyroid nodules,there were 163 grade 3 nodules（26.5%）,61 grade 4a nodules（9.9%）,149 grade 4b nodules（24.2%）,158 grade 4c nodules（25.6%）,83 grade 5 nodules（13.5%）,and 2grade 6 nodules（0.3%）.There were 465 cases（75.5%）with no combined Hashimoto’s thyroiditis and 151 cases（24.5%）with combined Hashimoto’s thyroiditis.Univariate analysis revealed statistically significant differences in age,BMI,NLR,PLR,SII,TSH,FT4,and combined Hashimoto’s thyroiditis between the benign and malignant groups（P < 0.05）.A binary logistic regression was performed to conclude that high BMI（95%CI 1.037～1.167,OR=1.100,P=0.002）,high SII（95%CI1.004～1.009,OR=1.007,P < 0.001）,low FT3（95%CI 0.536～0.962,OR=0.718,P=0.026）,combined with Hashimoto’s thyroiditisand（95%CI1.009～2.758,OR=1.668,P=0.046）and age <55 years（95%CI 0.247～0.601,OR=0.386,P<0.001）were independent risk factors for PTC.To further clarify the diagnostic efficacy of inflammatory markers for PTC,ROC curve plotting was performed,and the area under curve（AUC）was obtained as 0.736（95% CI 0.696-0.777,P < 0.001）for NLR,0.642（95% CI 0.596-0.687,P < 0.001）for PLR and 0.790（95% CI 0.754-0.826,P < 0.001）for SII.The corresponding cut-off values for the three at the maximum of the Jorden index were 1.88（sensitivity of 63.9% and specificity of 72.5%）,111.55（sensitivity of 79.1% and specificity of 42.6%）,and444.42×109（sensitivity of 70.6% and specificity of 76.5%）,respectively.Therefore,the diagnostic efficacy of the three is SII > NLR>PLR.Subsequently,the effect of the size of NLR,PLR,and SII on the clinicopathological factors of PTC patients was explored using univariate analysis,and it was concluded that the differences between PTC patients with high NLR values compared to those with low NLR values were statistically significant（P < 0.05）in terms of the presence of lymph node metastasis in the central region and the maximum diameter of the tumor,while the differences between BMI,TSH,FT3,FT4,Tgab,Tpoab,gender,age,whether multifocal,whether bilateral cancer,whether invasion of the perineurium,whether lateral cervical lymph node metastasis,and whether combined with Hashimoto’s thyroiditis were not statistically significant（P > 0.05）.Compared with patients with low PLR values,the differences between patients with PTC with high PLR values were statistically significant in terms of BMI,gender,and age（P<0.05）,while the differences in TSH,FT3,FT4,Tgab,Tpoab,whether multifocal,whether bilateral cancer,whether invasion of the perineum,whether lymph node metastasis in the central region,whether lateral cervical lymph node metastasis,whether combined with Hashimoto’s thyroiditis and difference between the maximum tumor diameter（P > 0.05）was no statistically significant.Compared with low SII values,the differences between PTC patients with high SII values were statistically significant（P < 0.05）in terms of FT3,age and the presence of lymph node metastasis in the central region,and between TSH,FT4,Tgab,Tpoab,whether multifocal,whether bilateral cancer,whether invasion of the perineum,whether lateral cervical lymph node metastasis,whether combined with Hashimoto’s thyroiditis and the maximum diameter of the tumor The differences were not statistically significant（P > 0.05）.Conclusion:1.The efficacy of SII for risk assessment of thyroid nodules is better than NLR and PLR.2.SII >335.38×109 not only indicates a higher risk of nodal malignancy,but also can be used as a basis for initial screening of malignant nodules.3.PTC patients with pre-surgical NLR >1.88 were more likely to suffer from central lymph node metastasis.4.PTC patients with pre-surgical SII > 444.42 ×109 had the higher risk of big cancer size and central lymph node metastasis. |
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