The Predictive Value Of Preoperative Whole Blood NLR,PLR And TSH In Cervical Lymph Node Metastasis Of Thyroid Papillary Carcinoma

Objective: It is to explore the correlation between the preoperative Neutrophil-to-lymphocyte Ratio(NLR),the Platelet-to-lymphocyte Ratio(PLR),Thyroid-stimulating Hormone(TSH)of whole blood,and cervical Lymph Node Metastasis(LNM)in patients with Papillary Thyroid Carcinoma(PTC)in order to provide reference for predicting lymph node metastasis in patients and guiding the scope of intraoperative dissection of PTC.Methods: This study collected retrospectively the clinical data of361 patients who were treated in the Breast and Thyroid Surgery Department of the First Affiliated Hospital of University of South China from January 1,2015 to November 1,2020,undergone thyroidectomy,and postoperatively diagnosed as cases with PTC to conduct a retrospective and observational study.Among them,114 cases were males(31.59%),247 women(68.41%)with the average age of46.74(the ages were from 15 to 86).The blood routine examination of the above patients was collected,including leucocyte count,neutrophil count,monocyte count,lymphocyte count,albumin value,hemoglobin value,fibrin original value,and creatinine;2)the thyroid function were also collected,including free triiodothyronine(FT3),free thyroxine(FT4),TSH,Thyroglobulin antibody(Tg Ab),and Thyroid Peroxidase antibody(TPOAb);3)The postoperative pathological information of the patients was collected,and the number of the cervical lymph node metastasis was recorded.The propensity score matching(1:1)was applied to eliminate the potential effects of Body Mass Index(BMI),albumin,and creatinine on blood routine examination and thyroid function.According to whether lymph node metastasis is found,they are divided into lymph node metastasis group and non-metastasis group.In comparison with the differences of baseline characteristics and the differences of each observation index between the above two groups,and the differences of measurement data are compared by t-test,the differences of counting data are compared by chi-square test.it was concluded that there were statistical differences in NLR,PLR and TSH.The weight of NLR,PLR,TSH and their combination in predicting lymph node metastasis was analyzed by logistics regression model.and receiver operating characteristic(ROC)curve of each index or joint index is constructed by SPSS25.0 software.Z test was used to compare whether there were statistical differences in the Area Under Curve(AUC)of the above four indicators.The sensitivity and specificity of the critical value and the corresponding critical value are calculated so as to judge the effectiveness of the above indicators in predicting the preoperative cervical lymph node metastasis of the papillary thyroid carcinoma.Results:Among the collected 361 cases with papillary thyroid carcinoma,in contrast to the lymph node negative group,the peripheral blood lymphocytes of the lymph node metastasis group decreased,while their TSH increased,which were statistically significant(p<0.05).In order to eliminate the confounding factors,the paired propensity score(1:1)was applied to balance the confounding factors,such as gender,BMI,creatinine,and albumin.Both positive and negative lymph node metastasis groups were 172 patients.In comparison with the negative group of lymph node metastasis,platelets,lymphocytes,monocytes,neutrophils,TSH,PLR,and NLR in the positive group were statistically significant(p<0.05).ROC curves of NLR,PLR,TSH and the combined indicators were constructed.The optimal cut-off value of NLR for predicting cervical lymph node metastasis of the papillary thyroid carcinoma was 7.60(sensitivity 83%,specificity 61%,and the AUC0.7697).The optimal cut-off value of PLR for predicting cervical lymph node metastasis of papillary thyroid carcinoma was 120.99(sensitivity61%,specificity 66%,and AUC 0.6762).The optimal cut-off value of TSH for predicting cervical lymph node metastasis of papillary thyroid carcinoma was 1.78(sensitivity 63%,specificity 63%,and AUC 0.6114).The optimal cut-off value for the combined indicators to predict cervical lymph node metastasis of papillary thyroid carcinoma was 0.48(sensitivity 72%,specificity 74%,and AUC 0.7894).The PLR,NLR,TSH and the combined indicators were significant in predicting preoperative lymph node metastasis of papillary thyroid carcinoma,while there was no significant difference in the AUC of PLR,NLR,TSH and the combined indicators when the pairwise comparison was conducted(p>0.05).Conclusions:1.Preoperative NLR,PLR,TSH and their combined indexes have certain clinical predictive significance in judging lymph node metastasis of thyroid papillary carcinoma,and have potential value in guiding clinicians to perform intraoperative cervical lymph node dissection.2.There was no significant difference in the predictive efficacy of preoperative NLR,PLR,TSH and their combination indexes for cervical lymph node metastasis of thyroid papillary carcinoma.Clinicians can use NLR,PLR and other relatively simple indicators as a reference for patients’ preoperative decision-making.