Glucose-to-Lymphocyte Ratio (GLR) as a Predictor of Preoperative Central Lymph Node Metastasis in Papillary Thyroid Cancer Patients With Type 2 Diabetes Mellitus and Construction of the Nomogram

Abstract

BackgroundDetection of metastasis of central lymph nodes in papillary thyroid cancer is difficult before surgery. The role of routine or preventive central lymph node dissection in the management of papillary thyroid cancer remains inconclusive. Moreover, glucose metabolism and systemic inflammation are related to the aggressiveness of several malignant tumors and the prognoses of these patients. This study aimed to construct a nomogram based on the readily available preoperative clinical features for predicting the occurrence of preoperative central lymph node metastasis in patients with papillary thyroid cancer and type 2 diabetes mellitus. The findings may underlie clinical implications for determining the appropriate treatment strategies for these patients.MethodsA total of 419 patients were enrolled. We used the receiver operating characteristic curves to determine the best cut-off value and converted the continuous into categorical variables. Next, a single-factor logistic analysis for the independent variables was performed, following which a multivariate regression analysis was conducted for the selected significant risk factors. Finally, the nomogram was constructed and verified using external data; the existing data were compared with the original model.ResultsAccording to the receiver operating characteristic curves, the best cut-off values ​​for glucose-to-lymphocyte ratio and tumor size were 4.23 cm and 0.95 cm, respectively. Findings from the multivariate logistic regression analysis suggested that age, bilateral tumors, maximum tumor size, and the ratio of glucose-to-lymphocytes were independent risk factors for preoperative central lymph node metastasis. The C-indexes in the training and the external validation data sets were 0.733 and 0.664, respectively. Both calibration curves and the Hosmer-Lemeshow tests indicated that the model was well-calibrated. Through decision curve analysis, the predictive model was estimated to have strong clinical applicability and greater benefits. To compare the performance of the new with that of the original model, we performed a net reclassification index and the integrated discrimination improvement analyses, both of which indicated that the new model had a better predictive ability.ConclusionIn patients with type 2 diabetes mellitus and papillary thyroid cancer, a high preoperative glucose-to-lymphocyte ratio was an independent predictor of the preoperative central lymph node metastasis. The nomogram so constructed could better predict the preoperative central lymph node metastasis in these patients.

Prediction of hematologic toxicity in luminal type breast cancer patients receiving neoadjuvant chemotherapy using CT L1 level skeletal muscle index

“…Additionally, while the GLR has prognostic significance for the detection of various malignant tumors 24 , 25 , its role in predicting chemotherapy-related hematologic toxicity has not been reported. Our findings showed that a high GLR value may also be a risk factor influencing severe hematologic toxicity.…”

Association between high serum blood glucose lymphocyte ratio and all-cause mortality in non-traumatic cerebral hemorrhage: a retrospective analysis of the MIMIC-IV database

“…The prognostic significance of the GLR has been demonstrated in studies involving metastatic gastric cancer (mGC) and metastatic breast cancer (MBC) patients receiving Cdk 4/6 inhibitors ( 16 ). Additionally, in patients with type 2 diabetes and MBC, the preoperative hyperglycemia to lymphocyte ratio was found to be an independent predictor of preoperative central lymph node metastasis ( 18 ). Constructing a column-line graph could enhance the predictive accuracy of preoperative central lymph node metastasis in these patients.…”

“…The elevated GLR may serve as an indicator of the combined impact of hyperglycemia and immune dysfunction in critically ill individuals. Current clinical studies suggest that elevated GLR is an important predictor of acute mortality and prognosis in patients with gastric cancer ( 16 ),hepatocellular carcinoma ( 17 ), breast cancer, thyroid cancer, rectal cancer ( 18 ), acute respiratory distress syndrome and acute exacerbation of chronic obstructive pulmonary disease ( 11 ).Therefore, it has important clinical significance in terms of malignant tumor disease burden and respiratory disease burden. The aim of this study was to evaluate the correlation between GLR at admission and prognosis of hospitalization in patients with non-traumatic cerebral hemorrhage.…”

Association between blood inflammatory indicators and prognosis of papillary thyroid carcinoma: a narrative review

“…Diabetes mellitus is known to be closely associated with cancer because it causes increased mortality in patients with cancer, and hyperglycemic states might impair the duration of survival and outcomes in cancer patients ( 46 ). Jin et al ( 47 ) revealed that a high preoperative GLR was an independent predictor of LNM in the central region in patients with PTC accompanied by type 2 diabetes.…”