cN0甲状腺微小乳头状癌中央区淋巴结转移风险分析及对手术的指导意义

目的分析cN0甲状腺微小乳头状癌（PTMC）发生中央区淋巴结转移的危险因素。方法收集200例cN0 PTMC病人的临床资料，包括性别、年龄、术前促甲状腺激素、BRAF基因突变与否、肿瘤直径、多灶性、单/双侧、是否合并慢性淋巴细胞性甲状腺炎、是否侵犯包膜，是否腺体外侵犯及术后病理。根据中央区淋巴结是否转移将病人分为淋巴结阳性组和淋巴结阴性组，分析cN0 PTMC发生中央区淋巴结转移的危险因素。结果单因素分析显示，年龄、肿瘤直径、多灶、侵犯包膜、腺体外侵犯、BRAF基因突变与PTMC病人发生中央区淋巴结转移具有相关性（P < 0.05~P < 0.01）。多因素logistic回归分析显示，年龄、肿瘤直径、多灶、侵犯包膜、BRAF基因突变阳性是中央区淋巴结转移的独立危险因素（P < 0.05~P < 0.01）。结论针对PTMC病人，如有年龄较小、肿瘤直径较大、多病灶、侵犯包膜、BRAF基因突变阳性的临床特征，中央区淋巴结转移的风险较高，即使术前评估中央区淋巴结为阴性，手术范围也应包含中央区淋巴结的清扫，减少癌症残留及复发的风险。

Risk analysis of lymph node metastasis of cN0 papillary thyroid microcarcinoma in region VI and its guiding significance for surgery

ObjectiveTo analyze the risk factors of central lymph node metastasis in cN0 papillary thyroid microcarcinoma (PTMC).MethodsThe clinical data of 200 patients with cN0 PTMC were collected, which included gender, age, preoperative TSH, BRAF gene mutation or not, tumor diameter, multiple lesions, unilateral/bilateral, combining chronic lymphocytic thyroiditis or not, envelope invasion or not, extragland invasion or not, and postoperative pathology.The patients were divided into lymph node positive group and lymph node negative group according to the central lymph node metastasis or not, and the risk factors of central lymph node metastasis of cN0 PTMC were analyzed.ResultsUnivariate analysis showed that age, tumor diameter, multiple lesions, envelope invasion, extragland invasion, BRAF gene mutation were associated with central lymph node metastasis in patients with PTMC(P < 0.05 to P < 0.01).Multivariate logistic regression analysis showed that age, tumor diameter, multiple lesions, envelope invasion, and BRAF gene mutation were the independent risk factors for central lymph node metastasis(P < 0.05 to P < 0.01).ConclusionsFor PTMC patients, if there are clinical features of younger age, larger tumor diameter, multiple lesions, envelope invasion, and positive BRAF gene mutation, the risk of central lymph node metastasis is higher.Even if the preoperative assessment of central lymph node is negative, the scope of surgery should also include the dissection of central lymph nodes to reduce the risk of residual cancer and recurrence.