甲状腺微小乳头状癌与颈部淋巴结转移的相关性探讨

目的探讨甲状腺微小乳头状癌(PTMC)与颈部淋巴结转移的关系。方法回顾性分析2015年6月至2018年6月首次就诊于重庆市肿瘤医院405例PTMC患者的临床资料,应用χ2检验和多因素Logistic回归模型分析颈部中央区、颈侧区淋巴结转移的危险因素。结果 405例PTMC患者中央区淋巴结转移有94例(22. 21%),颈侧区转移有18例(4. 44%),单因素分析证明,多灶性、被膜侵犯与中央区淋巴结转移有关(P 0. 05),神经侵犯与颈侧区淋巴结转移有关(P 0. 05)。多因素分析证明,多灶性是PTMC中央区淋巴结转移的独立危险因素(P 0. 01)。结论对于多灶性、被膜侵犯等特征的PTMC患者建议预防性行中央区淋巴结清扫,有神经侵犯的PTMC患者一定要注意是否有颈侧淋巴结转移,根据体征、影像学检查结果行选择性颈侧区淋巴结清扫。     

预防性颈中央区淋巴结清扫对cN0期甲状腺乳头状癌疗效的Meta分析

目的 探讨预防性颈中央区淋巴结清扫术(PCND)在cN0期甲状腺乳头状癌(PTC)患者手术治疗中的临床应用价值。方法 分别以“甲状腺乳头状癌、预防性颈中央区淋巴结清扫、复发、并发症”和“papillary thyroid carcinoma、prophylactic central neck dissection/prophylactic central cervical lymph node dissection、recurrence、complication”为中英文检索词,检索PubMed、EMbase、The Cochrane Library、CNKI、万方数据库、中国生物医学文献数据库,限定文献发表年限为2007—2017年,纳入比较单纯行甲状腺乳头状癌原发灶手术治疗(对照组)和同时加行预防性颈中央区淋巴结清扫(观察组)临床疗效的队列研究,由两名研究者独立筛选文献与提取数据,并进行质量评价。计数资料采用优势比(OR)及95%可信区间(CI)表示。采用I²进行异质性分析。结果 共纳入符合筛选标准的文献10篇,均为回顾性队列研究,共3 383个研究对象,其中对照组1 797例,观察组1 586例。Meta分析结果显示:观察组与对照组局部复发率之间的差异无统计学意义(OR=0.97,95%CI 0.63～1.50, P=0.90)。与对照组相比,观察组术后暂时性低钙血症(OR=2.20,95%CI 1.81～2.68, P＜0.000 01)、永久性低钙血症(OR=3.02,95%CI 1.97～4.61,P＜0.000 01)、暂时性喉返神经损伤(OR=1.58,95%CI 1.06～2.34, P=0.02)、永久性喉返神经损伤(OR=1.90,95%CI 1.10～3.58, P=0.05)的发生率均增高,且差异均有统计学意义。结论 对于cN0期PTC患者,在原发灶手术治疗的同时行PCND并不能降低肿瘤的局部复发率,但却能明显增加手术并发症风险;因此,不推荐临床常规实施该术式。     

甲状腺乳头状癌颈部淋巴结转移特点及相关危险因素分析

目的 探讨甲状腺乳头状癌（PTC）临床病理特征及影响颈部淋巴结转移的危险因素。方法 回顾性分析我院2015年1月~2017年12月收治的515例PTC的临床资料,分析颈部淋巴结转移特点及相关危险因素。结果 PTC颈部淋巴结转移率为44.27%,中央组（Ⅵ区）淋巴结转移率高于侧区（P＜0.05）。单因素分析结果示性别、年龄、多灶、癌灶最大径、侵犯被膜和颈部淋巴结转移有关（P＜0.05）。多因素分析结果示男性、年龄＜55岁、多灶病变、癌灶最大径＞10 mm、被膜受侵犯是发生颈部淋巴结转移的独立危险因素（P＜0.05）。结论 Ⅵ区转移率最高,行颈淋巴结清扫时应将Ⅵ区作为常规清扫区域。对于男性、年轻、多灶病变、癌灶最大径＞10 mm、被膜受侵犯的患者应高度警惕颈部淋巴结转移的可能。     

单灶性甲状腺乳头状癌的临床、血清学和超声影像特征及中央区淋巴结转移危险因素分析

目的探究单灶性甲状腺乳头状癌(PTC)的临床、血清学和超声影像特征及中央区淋巴结转移(CLNM)相关的危险因素。方法选择2015年2月至2019年2月收治的246例单灶性PTC患者,其中男性146例,女性100例,年龄32～81岁,平均年龄63.33岁。收集患者的临床、血清学及超声影像特征,根据组织病理学检查结果判断有无CLNM,分析与临床、血清及超声因素间关系。确定影响颈部CLNM的独立危险因素。结果经病理诊断证实,246例患者中有86例(34.96%)发生CLNM,160例(65.04%)未发生CLNM,术前超声诊断CLNM真阳性79例,真阴性143例,假阳性7例,假阴性17例,灵敏度为91.86%,特异度为89.38%,准确率为90.24%。发生CLNM与未发生CLNM的患者在年龄、性别、甲状腺球蛋白(Tg)、术前甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、结节位置、肿瘤最大直径、紧贴被膜、回声上,差异均有统计学意义(P 0.05)。将年龄、性别、Tg、TPOAb、TGAb、结节位置、肿瘤最大直径、紧贴被膜、回声带入Logistic回归方程计算发现,上述因素比值比(OR)均 1,均是引起单灶性PTC患者发生CLNM的影响因素。结论单灶性PTC患者发生CLNM的危险因素为年龄、性别、Tg、TPOAb、TGAb、结节位置、肿瘤最大直径、紧贴被膜、回声,临床一旦发现,应考虑行中央区淋巴结清扫。     

甲状腺乳头状癌淋巴结转移的风险因素分析

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理学特征及淋巴结转移的风险因素。方法收集504例PTC手术标本,回顾性分析患者的临床资料及病理特点,通过单因素和多因素分析淋巴结转移的危险因素。结果(1)中央区淋巴转移中男性(47.58%)、年龄45岁(43.49%)、合并结节性甲状腺肿(46.20%)的患者转移率均显著增高;侧颈区淋巴结转移中男性(32.26%)、肿瘤最大径 1 cm(26.08%)、多发病灶(28.64%)、合并结节性甲状腺肿(32.28%)及合并淋巴细胞性甲状腺炎(36.73%)、双侧病变(33.08%)的患者转移率均显著增高。多因素分析显示,患者性别、结节性甲状腺肿是中央区淋巴结转移的独立危险因素;患者性别、肿瘤最大径、结节性甲状腺肿及病变位置(单/双侧)是侧颈区淋巴结转移的独立危险因素。(2)单因素分析显示,多个淋巴结转移中肿瘤最大径 1 cm(14.35%)、伴钙化(24.24%)、合并结节性甲状腺肿(18.35%)及合并淋巴细胞性甲状腺炎(28.30%)、双侧病变(17.78%)的患者转移率均显著增高。多因素分析显示,肿瘤最大径、合并淋巴细胞性甲状腺炎及结节性甲状腺肿是多个淋巴结转移的独立危险因素。结论 PTC患者的性别、年龄、肿瘤直径等临床病理学特征是淋巴结转移的危险因素,有望成为临床术前或术中诊断PTC依据,为制定合理的治疗方案提供帮助。     

甲状腺乳头状癌颈部Ⅱb区淋巴结转移特点及相关因素分析

目的探讨甲状腺乳头状癌颈部Ⅱb区淋巴结转移规律及相关因素分析。方法回顾性分析2006年1月至2013年1月在广西医科大学附属肿瘤医院接受患侧同期颈淋巴结清扫术的甲状腺乳头状癌患者的临床资料,共纳入能够获得Ⅱa、Ⅱb、Ⅲ、Ⅳ、Ⅴ及Ⅵ区淋巴结转移情况的病人资料共61例,其中3例为双侧甲状腺乳头状癌伴双侧颈部淋巴结转移,共计算64侧颈各区淋巴结转移率,并分析各个临床指标,包括性别、年龄、T分期、颈部各区淋巴结转移率等与11b区转移的相关性。结果61例病人,共64侧颈Ⅱ、Ⅲ、Ⅳ、Ⅴ及Ⅵ区淋巴结转移率分别为34．4％（22／64）、43．8％（28／64）、42．2％（27／64）、25．0％（16／64）和48．4％（31／64）,其中Ⅱa和Ⅱb区淋巴结转移率分别是25．0％（16／64）和9．4％（6／64）。多因素分析显示Ⅱa区淋巴结转移是Ⅱb区淋巴结转移的独立危险因素。结论甲状腺乳头状癌颈部Ⅱb区淋巴结转移率较低,如果出现Ⅱa区淋巴结转移则Ⅱb区应行常规清扫。     

甲状腺乳头状癌合并桥本甲状腺炎的临床病理特征及淋巴结转移因素分析

目的 探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)合并桥本甲状腺炎(Hashimoto's thyroiditis,HT)的临床病理特征、肿瘤免疫微环境类型及淋巴结转移的危险因素.方法 收集HT伴PTC(HT+PTC)标本89例,应用免疫组化CD8染色进行肿瘤免疫微环境分型,α-...     

Risk factors for predicting central lymph node metastasis in papillary thyroid microcarcinoma

Objectives: We aimed to determine the predictive factors for central compartment lymph node metastasis (LNM) in papillary thyroid microcarcinoma (PTMC). The outcome of the current study could assist greatly in decision-making regarding further treatment. Methods: Retrospective analysis of PTMC treated at the First Affiliated Hospital of Harbin Medical University. The predictive risk factors for central lymph node metastases (CLNM) were analyzed with respect to age, sex, tumor size, multifocal and capsular affection. Results: CLNM are common in thyroid microcarcinoma patients. The factors correlated with neoplasm size greater than 5 mm (odds ratio, 0.520; P = 0.001), tumor bilateral (odds ratio, 0.342; P = 0.020), and capsule invasion (odds ratio, 2.539; P = 0.000) were independently predictive of CLNM. In patients with a solitary primary tumor, tumor location in the lower third of the thyroid lobe was associated with a higher risk of CLNM. Conclusions: The risk factors such as male gender, tumor size > 5 mm, bilateral, multifocal location, lower third of the thyroid lobe and capsule invasion that can be identified preoperatively or intraoperatively, be considered for determination of prophylactic CLND in patients with PTMC.     

Impact of clinicopathologic factors on subclinical central lymph node metastasis in papillary thyroid microcarcinoma

Purpose: We evaluated whether the clinicopathological factors of papillary thyroid microcarcinoma (PTMC), especially tumoe size, are associated with subcinical central lymph node metastasis. Materials and Methods: A total of 160 patients diagnosed with PTMC who underwent total thyroidectomy with bilateral central lymph node dissection were enrolled in this study. All patients were clinically lymph node negative PTMC. Patients were divided into 2 groups according to the size of tumor (≤5 mm vs. >5 mm). Clinicopathologic risk factors for subclinical central lymph node metastasis were analyzed. Results: Subclinical central lymph node metastasis was detected in 61 (38.1%). Patients with tumors ≤5 mm had a lower frequency of extrathyroidal extension, multifocality and subclinical central lymph node metastasis. On multivariate analysis, only male and tumor size >5 mm were independent predictors of subclinical central lymph node metastasis; age, multifocality, bilaterality, extrathyroidal extension, lymphvascular invasion and lymphocytic thyroiditis were not. Conclusion: In this study, male and tumor size >5 mm were two independent predictive factors for subclinical central lymph node metastasis in PTMC. These are easier factors to assess before surgery than other factors when planning the central lymph node dissection. However, further long-term follow-up studies are needed to confirm the prognostic significance of subclinical central lymph node metastasis in PTMC.     

Risk factors for central lymph node metastasis of patients with papillary thyroid microcarcinoma: a meta-analysis

Objective: To evaluate the risk factors of central lymph node metastasis of papillary thyroid microcarcinoma. Method: Published articles about papillary thyroid microcarcinoma were searched in PubMed, MEDLINE and EMBASE until October 2013 to examine the risky factors of central lymph node metastasis. Software RevMan 5.0 was used for meta-analysis. Results: Within the patients suffering papillary thyroid microcarcinoma underwent thyroidectomy plus prophylactic central lymph node dissection, tumor size, multifocality and capsular invasion have statistically relevant association with central lymph node metastasis, but no relation was observed associated with sex and age. Conclusion: The papillary thyroid microcarcinoma should be considered central lymph node metastasis when tumor size ≥0.5 cm, multifocality and have capsular invasion.     

Clinical and pathologic predictors of lymph node metastasis in papillary thyroid microcarcinomas

Papillary thyroid microcarcinoma (PTMC) has the highest incidence among all thyroid carcinomas. Although surgery is the primary treatment for PTMC, it inevitably leads to trauma and some complications. To formulate an optimal treatment strategy, we aim to clarify the risk factors for lymph node metastasis (LNM) in PTMC patients. This study retrospectively analyzed patients who underwent thyroidectomy during 1995–2015, and grouped them according to lymph node metastasis. Age, gender, tumor size, thyroid functions, Hashimoto's thyroiditis, multifocal tumor, extrathyroidal extensions, capsular invasion were analyzed. Of the 2434 PTMC subjects, proportion of patients with no LNM (NLNM), LNM, central LNM (CLNM), lateral LNM (LLNM), CLNM + LLNM were 82.9%, 17.1%, 7.0%, 7.6% and 2.5%. Patients with NLNM were older and had a lower proportion of males compared to patients with CLNM, LLNM and CLNM + LLNM (p < 0.05). The NLNM group also had a smaller size of ultrasound tumor, lower proportion of multifocal tumor and extrathyroidal extension compared to CLNM, LLNM and CLNM + LLNM groups (p < 0.05). On univariate analyses, male gender, age <45 years, tumor size of pathology (˃0.75 cm), multifocality, and extrathyroidal extension were significantly associated with LNM. Multivariate analyses revealed that male gender, age <45 years, multifocality were risk factors for LNM. In conclusion, PTMC patients with male gender, age <45 years and multifocality should be evaluated carefully for possible LNM.     

S100A4 expression is associated with lymph node metastasis in papillary microcarcinoma of the thyroid

The detection of papillary microcarcinomas of the thyroid is increasing due to frequent use of ultrasound and fine-needle aspiration biopsy. Although most of the papillary microcarcinomas remain quiescent and follow an indolent clinical course, some behave aggressively and metastasize early, giving rise to clinically significant disease. There have been few studies concerning factors predictive of lymph node metastasis in papillary microcarcinomas. We analyzed the expression of S100A4, cyclin D1, p27 and MUC1, the presence of the BRAF V600E mutation and the clinicopathological features of the tumors, including patient age, tumor size (>or=5 vs <5 mm), extrathyroidal extension, multifocality, histological subtype, sclerosis and encapsulation, in a series of 198 papillary microcarcinomas in relation to lymph node metastasis to determine the predictive factors of lymph node metastasis. On univariate analysis, tumor size of 5 mm or more, extrathyroidal extension, multifocality, sclerosis and the expression of S100A4 and cyclin D1 predicted lymph node metastasis, whereas patient age, expression of p27 and MUC1 and the BRAF V600E mutation did not. Moreover, tumor size 5 mm or more, multifocality and expression of S100A4, especially its strong expression in the invasive fronts, were significantly associated with macrometastasis and lateral node metastasis. On multivariate analysis, multifocality and expression of S100A4 were found to be common independent predictive factors of lymph node metastasis, macrometastases, and lateral node metastasis. In conclusion, S100A4 expression in papillary microcarcinomas may indicate the presence of nodal metastasis. Thus, S100A4 immunohistochemistry may be valuable for predicting metastatic potential in papillary microcarcinomas.     

Correlation analysis on central lymph node metastasis in 276 patients with cN0 papillary thyroid carcinoma

Objective: To explore the relationship between sex, age, capsule invasion, tumor size, tumor location, number and central lymph node metastasis. Methods: Correlation analysis was conducted on clinical data of 276 patients with cN0 papillary thyroid carcinoma who underwent central lymph node dissection. Results: There was significant difference between patients less than 45 years old and greater than or equal 45 years old (P<0.05), between patients with capsule invasion and without capsule invasion (P<0.05); there were significant differences in the central lymph node metastasis rate between group with Φ≤0.5cm as well as Φ>2cm and the other three groups (P<0.05), and there was significant difference between upper pole group and middle/lower pole group (P<0.05) while no significant difference was found between middle pole and lower pole (P>0.05); there was also no significant difference in the central lymph node metastasis rate between groups with 1 tumor and greater as well as equal 2 (P>0.05). Conclusion: We considered the tumor located in middle and lower pole, Φ>0.5cm of tumor size, less than 45 years old and the present of capsule invasion were high risk factors of central lymph node metastasis, so we strongly recommend performing central lymph node dissection in synchronization.     

Association between the HLA-G molecule and lymph node metastasis in papillary thyroid cancer

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer and can present as lymph node metastasis in 30 to 65% of cases when initially diagnosed. High frequency recurrence, distant metastasis and treatment resistance can be found in cases of PTC so early diagnosis and treatment are critical for improved prognosis and better survival rates. The characterization of new biomarkers has proved useful for the diagnosis and follow-up of these patients. HLA-G is a non-classical HLA class I molecule whose expression in cancer cells has been associated with tumor evasion of immune response. Therefore, the aim of this study was to investigate the HLA-G expression and its clinical significance in PTC. Paraffin-embedded thyroid biopsies of 70 PTC patients (40 of whom had presented with metastasis) were evaluated. HLA-G-staining was observed in tumor cells in PTC, and the HLA-G expression was significantly associated with an increased occurrence of lymph node metastasis (p = 0.0006) and capsular invasion (p = 0.02). This preliminary data shows the HLA-G expression in thyroid carcinoma specimens for the first time and suggests that this expression could impair efficient anti-tumor immunity in PTC. This would indicate that HLA-G could have an independent prognostic value in PTC, principally for tumor recurrence.