多灶性甲状腺乳头状癌颈部中央区淋巴结转移危险因素分析

目的: 探讨多灶性甲状腺乳头状癌(multifocal papillary thyroid carcinoma,MPTC)患者中央区淋巴结转移的规律及危险因素。方法: 回顾性分析2015年1月~2017年5月青岛大学附属医院收治的107例MPTC患者临床病理资料,包括性别、年龄、肿瘤部位、是否侵犯背膜、是否合并桥本甲状腺炎、癌灶总直径、癌灶数目等,探讨MPTC患者的中央区淋巴结转移(central lymph node metastasis,CLNM)规律及其危险因素。结果: 107例MPTC患者中,发生中央区淋巴结转移者56例(52.3 %)。预防性中央区淋巴结清扫个数为1～22个,平均(5.61±3.83)个,其中转移个数为0～10个,平均(1.36±1.95)个。单因素分析结果显示,背膜侵犯、性别、年龄(＜45岁)、癌灶数、癌灶总直径＞1 cm是MPTC患者中央区淋巴结转移的危险因素(P＜0.05)。多因素分析结果显示,癌灶数、癌灶总直径、背膜侵犯、年龄、男性均是MPTC患者发生中央区淋巴结转移的独立危险因素(P＜0.05)。结论: 多灶是甲状腺乳头状癌中央区淋巴结转移的危险因素,对于MPTC患者,尤其是肿瘤总直径＞1 cm、背膜侵犯、年龄＜45岁的男性MPTC患者,建议采用甲状腺全切除术加患侧中央区淋巴结清扫。

Analysis of the risk factors of lymph node metastasis in central cervical area of multifocalpapillary thyroid microcarcinoma

Objective: To investigate the regularity and risk factors of central lymph node metastasis (CLNM) in patients with multifocal papillary thyroid carcinoma (MPTC). Method: The clinicopathological data of 107 patients with MPTC admitted to the Affiliated Hospital of Qingdao University from January 2015 to May 2017 were retrospectively analyzed, including gender, age, tumor location, whether the dorsal membrane was invaded, whether Hashimoto' s thyroiditis was complicated, the total diameter of the tumor and the number of the tumor. The central lymph node metastasis (CLNM) and its risk factors in MPTC patients were discussed. Results: Among 107 MPTC patients, 56 patients (52.3 %) had central lymph node metastasis. The number of prophylactic central lymph node dissection was 1-22, with an average of (5.61±3.83), and the number of metastasis was 0-10, with an average of (1.36±1.95). Univariate analysis showed that dorsal membrane invasion, gender, age (<45 years old), number of cancer foci, and total diameter of cancer foci ＞ 1cm were risk factors for central lymph node metastasis in MPTC patients. Multivariate analysis showed that the number of cancer foci, total diameter of cancer foci, dorsal membrane invasion, age and male were independent risk factors for central lymph node metastasis in MPTC patients (P＜0.05). Conclusion: Multifocality is a risk factor for central lymph node metastasis in papillary thyroid carcinoma. For MPTC patients, especially those with total tumor diameter ＞ 1 cm, dorsal membrane invasion, age (＜45 years ) and male patients, total thyroidectomy and ipsilateral central lymph node dissection are recommended.