多灶性甲状腺乳头状癌的构成比变化及临床分析

目的 探讨甲状腺乳头状癌中多灶性甲状腺乳头状癌的构成比变化、淋巴结转移及预后等临床特点.方法 回顾性分析大连医科大学附属第一医院2002年1月-2011年12月首次诊断并接受手术治疗且术后病理证实为甲状腺乳头状癌的病例1616例,分析多灶性甲状腺乳头状癌占甲状腺乳头状癌的构成比变化;比较多灶性甲状腺乳头状癌组(A组)与单灶组(B组)及多灶性甲状腺乳头状癌组内不同亚组相关临床特点的差异.结果 多灶性甲状腺乳头状癌占甲状腺乳头状癌的构成比由2002年的8.33％(4/48)逐渐上升至2011年的30.38％(96/316).A组与B组相比有更高的颈部淋巴结转移率(45.09％ vs25.02％;P =0.000)和腺体外浸润率(20.95％vs 9.04％;P =0.000).多灶性甲状腺乳头状癌组中非单纯微小癌组比单纯微小癌组、病灶数目≥3个的病灶组比病灶数目为2个的病灶组发生颈部淋巴结转移的概率高(P＜0.001),而腺体外浸润发病率则差异均无统计学意义(P＞0.05).术后病理证实在多灶性甲状腺乳头状癌中有颈部淋巴结转移的患者比无淋巴结转移的患者复具有更高的复发率(24.05％ vs 8.98％;P=0.000).结论 多灶性甲状腺乳头状癌的患者数量及构成比呈逐年上升趋势;多灶性甲状腺乳头状癌组较单灶组易发生颈部淋巴结转移及腺体外浸润;非单纯微小癌组比单纯微小癌组、病灶数目≥3个的病灶组比病灶数目为2个的病灶组发生颈部淋巴结转移的概率高,而腺体外浸润发病率则无差别;颈部淋巴结转移与疾病的复发呈正相关.     

多灶性甲状腺乳头状癌的生物学特性及治疗分析

目的 探讨多灶性甲状腺乳头状癌的临床特性及治疗.方法 回顾性分析1995-1997年间在天津市肿瘤医院手术治疗并经病理证实的86例多灶性甲状腺乳头状癌的临床资料,研究其临床生物学特征.结果 多灶性甲状腺乳头状癌者共86例,占同期甲状腺乳头状癌的23.4%.病灶位于单侧12例,位于双侧74例;颈部淋巴结转移51例(59.3%);病灶中含微小癌者46例(53.5%);合并桥本甲状腺炎者23例(26.7%);周围组织侵犯19例(22.1%);发生远处转移者1例(1.2%);10年生存率95.3%.美国癌症联合会(AJCC)分期与预后相关(x2=63.395,P=0.000).结论 多灶性甲状腺乳头状癌多发生于双侧甲状腺,病灶中含微小癌者及合并桥本甲状腺炎者较多,AJCC分期是多灶性甲状腺乳头状癌的重要预后因素.     

甲状腺乳头状微小癌手术方式探讨

目的 探讨治疗甲状腺乳头状微小癌最佳的手术方式.方法 2000年1月-2010年1月139例甲状腺乳头状微小癌患者在济南军区总医院甲状腺乳腺外科接受了不同范围的甲状腺切除+选择性颈淋巴结清扫术,本文对其临床、病理和随访资料进行分析.结果 139例甲状腺乳头状微小癌患者中,甲状腺全切除者91例,甲状腺大部切除或次全切除者48例,癌灶直径平均为(0.45 ±0.24) cm其中42例(30.2％)甲状腺微小癌为多灶性,27例(19.4％)为双侧癌.59例(42.4％)伴有颈部淋巴结转移,其中Ⅵ、Ⅱa、Ⅲ或Ⅳ区淋巴结转移者分别为58例(41.7％)、3例(2.2％)、10例(7.9％)、5例(3.6％),仅有Ⅲ区淋巴结转移者1例.甲状腺乳头状微小癌颈淋巴结转移与微小癌浸润甲状腺被膜密切相关(x2=38.39,P＜0.001).本组病例随访30 ～154个月,中位随访时间为103个月,2例对侧残留腺叶复发.无永久性甲状旁腺功能减退发生.随访满10年者16例,10年生存率为100％.结论 多发癌灶和Ⅵ区淋巴结转移是甲状腺乳头状微小癌的2个重要的临床病理学特点.甲状腺乳头状微小癌初次手术时行甲状腺全切除+Ⅵ区淋巴结清扫是最佳的术式,可降低术后复发.     

多灶性甲状腺乳头状癌的临床病理及颈淋巴结转移特征

目的:探讨多灶性甲状腺乳头状癌(PTC)的临床病理及颈淋巴结转移特征。方法:回顾性分析2016年6月—2016年10月于郑州大学第一附属医院甲状腺外科行手术治疗并经术后病理证实的323例PTC患者的临床资料,其中多灶性PTC患者148例,单灶性PTC患者175例。结果:多灶性PTC患者与单灶性PTC患者间性别、年龄、癌灶最大径差异无统计学意义(均P0.05),但前者更易发生颈部中央区淋巴结转移(P0.001)、颈侧区淋巴结转移(P=0.028)及腺外浸润(P0.001);多灶性PTC患者中,癌灶数≥3的患者中央区淋巴结转移率(P=0.010)、侧区淋巴结转移率(P=0.018)及腺外浸润的发生率(P=0.020)明显高于癌灶数=2的患者;多因素分析显示,癌灶最大径(P=0.005)及癌灶数量(P=0.006)为多灶性PTC中央区淋巴结转移的独立危险因素。结论:多灶性PTC较单灶性PTC侵袭性强,更易发生转移、浸润,建议选择全甲状腺切除加中央区淋巴结清扫作为标准化手术方式,颈侧区存在可疑肿大淋巴结者应积极行颈侧区淋巴结清扫术。     

儿童甲状腺乳头状癌临床分析及肺转移风险因素讨论

目的 探讨分析儿童甲状腺乳头状癌临床特征及肺转移风险因素以指导临床工作.方法 收集2005-2016年郑州大学第一附属医院甲状腺外科收治的14岁以下首次行手术治疗并经过术后常规病理证实为甲状腺乳头状癌患者资料40例,将有关头颈部恶性肿瘤或淋巴瘤病史、继发性甲状腺癌、甲状腺功能亢进合并甲状腺乳头状癌,病例资料不完整的病例排除.40例患儿年龄3 ～ 14岁,其中男12例,女28例.最大肿瘤直径7.5 cm,最小肿瘤直径0.3 cm.肿瘤病灶单发22例,多发18例.肿瘤合并颈部淋巴结转移33例,无颈部淋巴结转移7例.肿瘤合并肺转移10例,无肺转移30例.采用x2检验和Logistic回归分析儿童甲状腺乳头状癌患者年龄、性别、肿瘤直径、病灶数、手术方式、颈部淋巴结转移等临床特征及肺转移相关风险因素.结果 儿童甲状腺乳头状癌肺转移的阳性率为25.0％(10/40),统计分析发现:肿瘤合并肺转移患儿阳性率在多发病灶数(x2=8.620,P=0.003)、肿瘤直径≥2 cm(x2=5.763,P=0.016)中较高且差异有统计学意义,经Logistic回归分析示:多病灶数是儿童甲状腺乳头状癌肺转移的危险因素(OR:13.058,P=0.028).结论 较高的肺转移率为儿童甲状腺乳头状癌的临床特征,对于多病灶的甲状腺乳头状癌患儿,肺转移风险明显增高.     

甲状腺乳头状微小癌术后复发的相关因素分析

目的：研究影响甲状腺乳头状微小癌（PTMC）术后复发的相关临床病理学因素。方法：回顾性分析124例PTMC患者的临床资料,采用单因素及多因素分析,探讨PTMC相关临床病理因素与术后复发的相关性。结果：平均随访57（18~120）个月,复发率为10.5%（13/124）,单因素分析显示肿瘤直径≥5 mm（P=0.013）、颈部淋巴结转移（P=0.001）、多发癌灶（P=0.007）及甲状腺包膜侵犯（P=0.000）与PTMC复发显著相关;多因素分析显示颈部淋巴结转移（P=0.001）、多发癌灶（P=0.007）及甲状腺膜包膜侵犯（P=0.000）与PTMC复发显著相关。结论：PTMC总体预后良好,但仍有较高的复发率,且复发与某些临床病理学因素显著相关,在决定手术方式时应充分考虑这些因素。     

全甲状腺切除+预防性中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌103例临床分析

目的总结多灶性甲状腺乳头状癌的临床病理学特征,评估全甲状腺切除+预防性中央区淋巴结清扫术在治疗多灶性甲状腺乳头状癌中的临床意义及安全性。方法回顾性分析2011年6月至2015年2月期间于湖北医药学院附属东风医院接受全甲状腺切除+预防性中央区淋巴结清扫术的103例多灶性甲状腺乳头状癌患者的病例资料。结果 103例多灶性甲状腺乳头状癌患者均行全甲状腺切除+预防性中央区淋巴结清扫术。单侧多发病灶55例(53.40%),双侧多发病灶48例(46.60%)。中央区淋巴结转移31例(30.10%),其中单侧多发病灶者中央区淋巴结转移16例(29.10%),均为患侧中央区淋巴结转移;双侧多发病灶者中央区淋巴结转移15例(31.25%),其中双侧转移7例,单侧转移8例。术后13例(12.62%)出现暂时性的低钙血症;1例(0.97%)发生永久性的甲状旁腺功能损伤;18例(17.48%)出现喉返神经短暂性麻痹,没有发生永久性喉返神经损伤的病例;3例(2.91%)术后出现短暂性饮水呛咳。术后所有患者均获访,随访时间为5个月~4年,中位数为28个月。随访期间3例(2.91%)出现侧颈区淋巴结转移。结论全甲状腺切除+预防性中央区淋巴结清扫术对治疗多灶性甲状腺乳头状癌有重要意义。     

cN0期甲状腺乳头状微小癌大容量中央区淋巴结转移的危险因素

目的:探讨c N0期甲状腺乳头状微小癌(PTMC)中央区淋巴结转移(CLNM),尤其是大容量淋巴结转移(LV-LNM,转移数目5枚)的危险因素。方法:回顾性分析512例行甲状腺全切或腺叶及峡部切除加中央区淋巴结清扫术的c N0期PTMC患者的临床资料,并根据CLNM转移情况将患者分为LV-LNM组和非LV-LNM组,分析c N0期PTMC患者CLNM及LV-LNM的危险因素。结果:512例患者中女415例(81.1%),男97例(18.9%),CLNM阳性者178例(34.8%),LV-LNM者21例(4.1%)。单因素分析显示,性别、年龄、癌灶直径、多灶性肿瘤、腺外侵犯及BRAF~(V600E)基因突变与CLNM有关(均P0.05);性别、年龄、多灶性肿瘤及腺外侵犯与LV-LNM有关(均P0.05)。多因素分析显示,男性(OR=1.451,95%CI=1.030～2.044,P=0.033)、年龄40岁(OR=1.720,95%CI=1.289～2.295,P=0.000)、癌灶直径0.5 cm(OR=1.677,95%CI=1.218～2.309,P=0.002)和多灶性肿瘤(OR=1.872,95%CI=1.384～2.532,P=0.000)是CLNM的独立危险因素;男性(OR=2.852,95%CI=1.773～4.588,P=0.000)、年龄40岁(OR=1.913,95%CI=1.434～2.552,P=0.000)及多灶性肿瘤(OR=1.579,95%CI=1.161～2.148,P=0.004)是LV-LNM的独立危险因素。结论:性别、年龄、癌灶直径和多灶性肿瘤是PTMC患者发生CLNM的高危因素,而男性、年龄40岁的多灶性c N0期PTMC患者更容易发生LV-LNM,应积极行预防性中央区淋巴结清扫术。     

甲状腺微小乳头状癌颈部淋巴结转移的危险因素分析

目的:探讨甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素。方法:回顾性分析贵州医科大学附属医院甲状腺外科2014年1月—2016年3月收治的169例PTMC患者临床病理资料。结果:169例患者均行预防性中央区淋巴结清扫,其中54例(32.0%)发生中央区淋巴结转移,单因素分析发现中央区淋巴结转移与年龄45岁、多灶性肿瘤、侵出包膜有关(均P0.05),多因素分析显示,年龄、多灶性肿瘤、侵出包膜都是中央区淋巴结转移的独立危险因素(均P0.05)。30例行中央区淋巴结加侧颈区淋巴结清扫,其中18例(10.7%)发生侧颈区淋巴结转移,单因素分析显示,肿瘤最大径、侵出包膜、多灶性肿瘤、中央区淋巴结转移与侧颈区淋巴结转移有关(均P0.05),多因素分析显示,肿瘤侵出包膜为侧颈区淋巴结转移的高危因素(P0.05);11例(6.5%)发生中央区并侧颈区淋巴结转移,侵出包膜、多灶性肿瘤为中央区并侧颈区淋巴结共同发生转移的高危因素(均P0.05)。高分辨率颈部淋巴结B超对中央区淋巴结转移的灵敏度、特异度分别为14.8%、96.5%,其对侧颈区淋巴结转移的灵敏度、特异度分别为94.4%、83.3%。结论:年龄45岁、多灶性肿瘤、侵出包膜是PTMC颈部淋巴结转移的危险因素。高分辨率颈部淋巴结B超可以作为甲状腺癌颈部淋巴结转移术前评估的重要手段。     

多灶甲状腺微小乳头状癌的临床特征分析

目的:探讨多灶甲状腺微小乳头状癌(PTMC)的临床病理特征。方法:回顾性分析2013年5月—2016年4月297例手术治疗并经病理证实的PTMC患者临床资料。结果:297例PTMC患者中,多灶PTMC 70例(23.6%)。与单灶PTMC患者比较,多灶PTMC患者肿瘤直径小(0.54 cm vs.0.69 cm)、包膜侵犯率高(18.6%vs.8.8%)、行甲状腺全切比例高(87.1%vs.41.4%),差异均有统计学意义(均P0.05)。癌灶数≥3多灶PTMC患者与癌灶数=2的PTMC患者比较,前者合并双侧癌的比例增高(88.2%vs.44.4%)、中央区淋巴结转移的比例增高(47.1%vs.22.2%),差异均有统计学意义(均P0.05)。结论:多灶PTMC的病灶更为微小且更易出现包膜侵犯;多灶PTMC的病灶数越多合并双侧癌和中央区淋巴结转移的风险就越大;多灶PTMC应常规行预防性中央区淋巴结清扫。     

甲状腺肿瘤组织中BRAF基因突变及临床意义

目的 探讨甲状腺良恶性肿瘤中BRAF基因点突变及在甲状腺乳头状癌(PTC)中BRAF突变与临床病理学特征之间的关系.方法 应用聚合酶链反应(PCR)技术和基因直接测序法检测104例甲状腺良恶性肿瘤组织中BRAF点突变.结果 在104例标本中,仅在PTC中检测到BRAF点突变,突变率为58.2%(46/79),其他类型的甲状腺良恶性肿瘤中均未检测到BRAF突变.在PTC中BRAF基因突变与肿瘤高分期、腺体外浸润及淋巴结转移呈正相关(P<0.05),而与患者的年龄、性别及肿瘤大小无明显相关(P>0.05).结论 BRAF基因突变是PTC中较常见的遗传学事件,它与肿瘤的分期、腺体外浸润及淋巴结转移具有重要关系.

Abstract：

Objective To investigate the BRAF mutation in benign and malignant thyroid tumors and its relationship with clinicopathological features in papillary thyroid cancer (PTC). Methods Polymerase chain reaction (PCR) and gene sequencing were performed to detect BRAF mutation in 104 cases of benign and malignant thyroid tissues. Results In 104 cases, BRAF mutation was detected in 46 out of 79 PTC cases with a detection rate of 58.2%. BRAF mutation was negative in other kinds of thyroid cancer and benign thyroid diseases. BRAF mutation in PTC was positively correlated with clinical stage, extra-thyroidal extension and lymph nodal metastasis (P<0.05), but not with age, gender and tumor size (P>0.05). Conclusion BRAF mutation was an important and common molecular hallmark of PTC and had a significant correlation with the clinical stage, extra-thyroidal extension and lymph nodal metastasis of PTC.     

甲状腺乳头状癌颈部淋巴结转移规律及影响因素分析

目的探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）颈部淋巴结的转移规律及其影响因素,为PTC颈部淋巴结清扫手术方式的选择提供依据。方法收集贵阳医学院附属医院甲状腺外科2009年1月至2011年12月期间收治的98例PTC患者的临床资料,对其淋巴结转移特点、规律及其影响因素进行回顾性分析。结果 98例患者中,共行颈部淋巴结清扫114侧。总颈淋巴结转移率为77.55%（76/98）,其中Ⅵ区淋巴结转移率为74.49%（73/98）,颈侧Ⅱ＋Ⅲ＋Ⅳ区为42.86%（42/98）,Ⅴ区为5.10%（5/98）。单因素分析结果显示：当肿瘤直径大于1 cm、侵犯甲状腺包膜、呈多灶性或年龄大于45岁时,Ⅵ区和Ⅱ＋Ⅲ＋Ⅳ区的淋巴结转移率较高（P〈0.05）。多因素分析结果显示：患者年龄、肿瘤直径、包膜侵犯及多灶性是颈部淋巴结转移的影响因素（P〈0.05）;包膜侵犯、多灶性、合并Ⅵ区淋巴结转移及合并颈侧Ⅱ＋Ⅲ＋Ⅳ区淋巴结转移是喉前淋巴结转移的影响因素（P〈0.05）;包膜侵犯和多灶性是跳跃性淋巴结转移的影响因素（P〈0.05）。结论 PTC易发生Ⅵ、Ⅲ及Ⅳ区淋巴结转移,应常规清扫Ⅵ区淋巴结。对颈部淋巴结转移规律的研究可为临床选择合理的颈部淋巴结清扫手术方式提供依据。     

甲状腺乳头状癌跳跃性侧颈区淋巴结转移的危险因素分析

目的探究甲状腺乳头状癌（PTC）颈部淋巴结跳跃性转移的临床病理特征及其危险因素。 方法回顾性分析2015年7月至2018年11月福建医科大学附属协和医院收治的259例PTC患者临床资料,探究跳跃性侧颈区淋巴结转移的危险因素。 结果PTC颈部淋巴结跳跃性转移的发生率为9.3%（24/259）。单因素分析显示,中央区淋巴结清扫数目在跳跃性转移组中更少（P=0.031）;肿瘤最大径<1 cm（P<0.001）及肿瘤位于腺体上部（P=0.012）与PTC患者跳跃性转移的发生有关。多因素分析显示,肿瘤最大径<1 cm（OR=5.934,P<0.001）和肿瘤位于腺体上部（OR=2.812,P=0.023）是PTC患者颈部淋巴结跳跃性转移的独立危险因素。 结论肿瘤最大径<1 cm和肿瘤位于腺体上部的PTC患者侧颈区淋巴结更易发生跳跃性转移。     

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??Correlative factors of lymph node metastasis in central region and cervical region of papillary thyroid carcinoma LU Xiu-bo. Department of Thyroid Surgery??the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,China
Abstract Thyroid cancer is the most common malignant tumor of endocrine tumors. The incidence of thyroid cancer is increasing in recent years. Differentiated thyroid carcinoma (DTC) accounts for about 95% of all thyroid cancers, with papillary thyroid carcinoma (PTC) accounting for more than 90% of DTC. Most PTCs grew slowly, but cervical lymph node metastasis occurred early. Neck lymph node metastasis is the main reasons for the high recurrence rate and low survival rate of thyroid cancer patients. Therefore, it is very important to explore the risk factors of lymph node metastasis. The article analyzed the risks of lymph nodes metastasis by reviewing the related literature. The results show that tumor diameter, age, gender, extrathyroid extension, BRAFV600E mutation are the risks factor for lymph node metastasis of lateral and central neck.     

中央区淋巴结转移强度对甲状腺乳头状癌颈侧区淋巴结转移的临床意义

目的:应用中央区淋巴结转移（central lymph node metastasis,CLNM）强度概念,探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）颈侧区淋巴结转移（lymph node metastasis,LNM）危险因素及对其影响。方法:回顾性分析内蒙古医科大学附属医院...     

Clinical Significance of Delphian Lymph Node Metastasis in Papillary Thyroid Carcinoma

Background

Delphian lymph node (DLN) metastasis has long been considered a prognostic marker of head and neck malignancy. These days, the significance of DLN in thyroid cancer has come to the fore. The objective of the present study was to evaluate the clinical significance of DLN metastasis in patients with papillary thyroid cancer (PTC).

Patients and methods

The study was carried out between July 2009 and December 2011, and DLN was detected in 245 of 898 PTC patients who underwent total thyroidectomy and bilateral central compartment neck dissection. In those 245 patients DLN status was correlated with clinical and pathologic factors, including age, gender, tumor size, extrathyroidal extension (ETE), lymphovascular invasion (LVI), and central and lateral nodal metastasis.

Results

DLN metastasis was found in 20 % of the patients studied (49 of 245), and DLN metastasis was correlated with tumor size, multicentricity, bilaterality, and LVI excluding ETE (all p < 0.05). The proportion of male patients was higher in the DLN metastasis positive group than in the DLN metastasis negative group (34.7 vs. 13.3 %; p < 0.05). Most of the patients (95.9 %) with DLN metastasis had other central neck node metastasis, and the metastatic central lymph node ratio was higher (0.38 ± 0.23 versus 0.09 ± 0.16; p < 0.001) and lateral neck node metastasis was more common (2.6 vs. 32.7 % <0.001) than in patients without DLN metastasis. For central and lateral compartment nodal metastasis, DLN status had sensitivity, specificity, positive and negative predictive values of 100, 37.4, 58.1, and 100 %, and 85.3, 76.2, 97.4, and 32.7 %, respectively. Multivariate analysis showed that the factors affecting DLN involvement were tumor size and LVI. Patients with positive DLN were ~1.6 times more likely to have further central compartment disease and 3.6 times more likely to have lateral compartment disease.

Conclusions

DLN metastasis in patients with PTC is related to a number of poor prognostic factors. Furthermore DLN involvement implies that the patients are predicted to have heavy burden of central neck node metastasis and are more likely to have further lateral neck node metastasis. It is recommended that DLN is evaluated and dissected in all patients with thyroid cancer. If DLN metastasis is suspected, the surgeon should thoroughly dissect the central neck compartment and pay particular attention to the lateral lymph node compartments.     

Role of chronic lymphocytic thyroiditis in central node metastasis of papillary thyroid carcinoma

Objective (1) To investigate the role of chronic lymphocytic thyroiditis (CLT) in central node metastasis of papillary thyroid carcinoma (PTC) and (2) to evaluate the presence of chronic lymphocytic thyroiditis according to PTC-specific molecular markers. Study Design. Historical cohort study. Setting Academic medical center. Subjects and Methods All patients who underwent total thyroidectomy with central neck dissection for PTC at Oregon Health & Science University between 2005 and 2010 were screened for the presence of CLT and reviewed for clinical prognostic factors. Patients with inadequate central neck dissections were excluded. Molecular markers for PTC were analyzed on archived tumor samples. Results A total of 139 patients met selection criteria. The rate of CLT was 43.8%. The rate of central node positivity was 63%. Presence of CLT was associated with a significantly lower proportion of central node metastases (49% vs 74%, P = .003) and angiolymphatic invasion (31% vs 15%, P = .03). There was no significant difference in mean age, tumor size, and extracapsular extension. Molecular genotyping did not reveal a significant difference in the types of mutations found in both groups. Conclusion The data indicate a lower incidence of central compartment lymph node metastasis in those with CLT in this patient population, suggesting a potential protective role in tumor spread. The equal distribution of tumor mutations between the carcinomas with and without evidence of CLT argues against a mutation-specific antigen as the immunologic stimulus. Further research is needed to characterize the role of autoimmunity in thyroid cancer.     

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??Risk factors of central lymph node metastasis of papillary thyroid carcinoma?? A single-center retrospective analysis of 3273 cases LIU Wen, CHENG Ruo-chuan, SU Yan-jun, et al. Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
Corresponding author??CHENG Ruo-chuan, E-mail:cruochuan@foxmail.com
Abstract Objective To investigate the clinicopathological features of papillary thyroid carcinoma ??PTC??and the risk factors of central lymph node metastasis ??CLNM??. Methods The clinicopathological features in PTC patients with complete case data admitted from January 2007 to June 2016 in the First Affiliated Hospital of Kunming Medical University were analyzed retrospectively. The risk factors of CLNM were analyzed by χ2 test and multivariate logistic regression model.Results The CLNM rate of PTC was 40.6% ??1331/3273??. On average?? 7.0 ??4.0??12.0??central lymph nodes were dissected?? and 3.70??±3.84??lymph nodes were proved to be metastatic. Univariate analysis showed that gender?? age?? tumor diameter?? extrathyroid extension?? multifocality?? concurrent nodular goiter?? initial symptoms and observation or not were related to CLNM??P??0.05??. Tumors located in the lower part of the thyroid ??41.6%??was the risk factor for CLNM ??P??0.001??, while multifocality was unrelated ??P=0.68??. The metastasis rate of bilateral multiple regions??51.3%???? unilateral multiple regions ??47.2%???? single region ??36.7%????P=0.003??. Multivariate logistic regression analysis showed that gender?? age?? tumor diameter?? extrathyroidal extension and observation were independent risk factors of CLNM. Conclusion Clinical and pathological features have certain predictive value for CLNM?? and can provide a reference for the treatment program of PTC patients.     

C MET蛋白在有颈部淋巴结转移的甲状腺癌中的表达和意义

目的探讨C-MET蛋白在有或无颈部淋巴结转移的甲状腺乳头状癌、甲状腺滤泡状癌及良性甲状腺组织中的表达及其临床意义。方法采用免疫组织化学方法检测有颈部淋巴结转移的甲状腺乳头状腺癌（PTC1组）62例，无颈部淋巴结转移的甲状腺乳头状腺癌（PTC2组）50例，甲状腺滤泡状腺癌（FTC组）l0例及良性甲状腺组织（良性组）30例中的C—MET蛋白的表达。结果PTCI组的C—MET表达明显高于其它3组（P〈0．001）。两两比较C—MET表达结果：PTC1组与PTC2组比较，P〈0．001；PTC1组与FTC组比较，P〈0．001；PTC1组与良性组比较，P〈0．001；PTC2组与FTC组比较，P=0．002；PTC2组与良性组比较，P〈0．001；皆有显著性差异。结论C—MET的表达是甲状腺乳头状癌是否有淋巴结转移的预测因子，是肿瘤的囊外扩展和直接侵犯的标记。该指标对甲状腺乳头状癌淋巴结转移的术前评估，决定手术方式均有一定指导意义。