甲状腺乳头状癌Ⅱ区淋巴结隐匿性转移的临床分析

目的 分析甲状腺乳头状癌Ⅱ区淋巴结隐匿性转移的相关因素。方法 回顾分析天津医科大学附属肿瘤医院头颈外科2003年1月至2009年12月收治的213例术前Ⅱ区淋巴结临床阴性,颈侧其他区阳性的初治甲状腺乳头状癌患者的临床资料。淋巴清扫标本经病理证实颈侧区（Ⅱ～Ⅴ）有淋巴转移。单因素和多因素分析分别采用卡方检验和二分类Logistic回归分析。结果 颈部Ⅵ区淋巴结转移率79.3％( 169/213),Ⅲ、Ⅳ、Ⅴ区淋巴结转移率分别为83.6％( 178/213)、75.1％ (160/213)、13.1％ (28/213),Ⅱ区隐匿性淋巴结转移率为16.0％(34/213)。单因素分析显示：术前颈侧区Ⅲ、Ⅳ区淋巴结同时阳性或者术前Ⅲ区淋巴结阳性,与Ⅱ区淋巴结隐匿性转移密切相关（x2值分别为11.120和5.614,P值均＜0.05）;多因素分析显示术前颈侧区Ⅲ、Ⅳ区淋巴结同时阳性是隐匿性Ⅱ区淋巴转移的独立危险因素(P=0.033,OR =3.846)。结论 甲状腺乳头状癌患者术前未发现Ⅱ区和Ⅲ区淋巴结阳性时,可以考虑暂时不进行预防性Ⅱ区颈淋巴清扫术。

Clinical analysis of level II occult metastasis of papillary thyroid carcinoma

Objective To analyze the relavent factors occult Ⅱ lymph node metastases in papillary thyroid carcinoma (PTC) with clinical factors. Methods The medical records of 213 PTC patients with clinically positive neck lymph nodes in level Ⅲ and Ⅳ, and/or Ⅴ based on preoperative ultrasonography,treated between January 2003 and December 2009 were retrospectively reviewed. All patients had no suspicion of clinical positive neck nodes in level Ⅱ. Univariate and Multivariate analysis were performed using the Pearson chi-square test or Fisher's exact test and a binary logistic regression test, respectively.Results The rate of metastasis at levels Ⅲ, Ⅳ, Ⅴ and Ⅵwas83.6％ (178/213),75. 1％(160/213),13. 1％(28/213) and 79.3％ ( 169/213), respectively. The rate of occult metastasis at level Ⅱ were observed in 16. 0％ (34/213). In univariate analysis, lymph node metastasis in level Ⅱ was statistically significantly more frequent in patients with positive level Ⅲ lymph node and positive lymph node throughout the lateral neck ( level Ⅲ + Ⅳ, x2 were 11. 120 and 5. 614 respectively, P ＜ 0. 05 ). Multivariate analysis showed that positive lymph node involvement in all lateral neck ( level Ⅲ + Ⅳ ) was an independent predictive factor of level Ⅱ lymph node metastasis ( P = 0. 033, OR = 3. 846). Conclusion In PTC patients without suspicious lymph node in neck level Ⅱ and Ⅲ by preoperative US, prophylactic level Ⅱ lymph node dissection may not be considered.