单侧cN0甲状腺乳头状癌颈中央区淋巴结转移的危险因素分析

目的 探讨单侧cN0甲状腺乳头状癌患者颈中央区淋巴结转移的危险因素。方法 回顾性分析2017年1月至2020年7月在安徽中医药大学第一附属医院行中央区淋巴结清扫的76例单侧cN0甲状腺乳头状癌患者的临床资料，患者根据术后病理分为中央区淋巴结阳性组（32例），中央区淋巴结阴性组（44例），通过单因素分析比较两组患者的临床特征（年龄、性别）、影像学资料（肿瘤位置、边界形态、是否钙化、纵横比）、病理资料（病灶数目、包膜侵犯、周围肌肉侵犯情况）及实验室检测数据[术前促甲状腺激素（TSH）、抗-甲状腺过氧物酶抗体（ANTI-TPO）和抗-甲状腺球蛋白抗体（ANTI-TG）水平]等指标的差异，对差异有统计学意义的指标采用多因素logistic回归分析患者发生颈中央区淋巴结转移的危险因素，通过受试者工作特征曲线（ROC）计算危险因素预测颈中央区淋巴结转移的曲线下面积（AUC）。结果 logistic回归分析显示，肿瘤最大径、年龄、肿瘤位置、术前TSH值以及是否多灶是颈中央区淋巴结转移的独立危险因素，肿瘤最大径、年龄、术前TSH值预测患者出现中央区淋巴结转移的AUC分别为0.689、0.672、0.700，截点分别为0.85 cm、41.5岁、1.35 mIU/L。结论 患者肿瘤最大径、术前TSH值、年龄、肿瘤位置、是否多灶是单侧cN0甲状腺乳头状癌患者中央区淋巴结转移的独立危险因素，肿瘤最大径、年龄、术前TSH值可用于预测中央区淋巴结转移。

Risk factors for central lymph node metastasis of unilateral cN0 Surgery, papillary thyroid carcinoma

Objective To investigate the risk factors of central lymph node metastasis in unilateral cN0 papillary thyroid carcinoma(cN0 PTC). Methods A retrospective study was performed on 76 cases of unilateral cN0 PTC undergoing central lymph node dissection from Jan 2017 to Jul 2020 in the First Affiliated Hospital of Anhui Medical University.According to postoperative pathology, the patients were divided into central lymph node positivity group (32 cases) and central lymph node negatie group (44 cases).The single factor analysis was used to compare the the difference between two groups of patients inclinical features (age, gender), image data (tumor location, boundary shape, whether calcification, aspect ratio) and pathological (number of lesions, coated violation, the surrounding muscles) and laboratory testing data[preoperative thyroid stimulating hormone (TSH), ANTI-thyroid peroxidase antibody (ANTI-TPO) and ANTI-thyroglobulin antibody (ANTI-TG) levels].Multiple logistic regression analysis was used to analyze the risk factors of cervical lymph node metastasis.ROC curve was applied to calculate the AUC of lymph node metastasis,which was used to evaluate the risk factors predicting value.Results Logistic analysis showed that tumor maximum diameter, age, tumor location, preoperative TSH values and whether multifocal were independent risk factors for cervical lymph node metastasis, the AUC about predicting value of tumor size, age, preoperative TSH was:0.689, 0.672, 0.700, respectively, the cut point was:0.85 cm, age 41.5, 1.35 mIU/L. Conclusions Preoperative TSH, age, tumor location and whether multifocal are independent risk factors for lymph node metastasis in patients with unilateral cN0 PTC, and maximum tumor diameter, age and preoperative TSH value can be used to predict central lymph node metastasis.