甲状腺乳头状癌术前超声特征及术后复发的危险因素

目的分析甲状腺乳头状癌（PTC）的术前超声特征及术后复发的危险因素。 方法选取2015年1月至2018年12月宣武医院收治的甲状腺乳头状癌患者320例，依据随访结果，将其分为未复发组292例和复发组28例。分别记录2组患者的性别、年龄、超声特征（肿瘤内部构成、回声、边界、形态、微小钙化、纵横比、TI-RADS分类4a~4b及4c~5）及病理特征（病灶大小、多灶性、被膜外侵犯、颈部淋巴结转移、手术方式），采用Cox比例风险回归分析术后复发的危险因素。 结果320例患者中有28例复发，复发率为8.75%。Cox单因素分析结果显示，4c~5 PTCs、肿瘤囊性变、肿瘤边界、纵横比、肿瘤大小、颈部淋巴结转移及手术方式均为肿瘤复发的危险因素（P<0.001、<0.001、=0.002、=0.006、=0.003、<0.001、=0.035）；多因素Cox比例风险回归分析结果显示，4c~5 PTCs、肿瘤囊性变、肿瘤大小、颈部淋巴结转移均是肿瘤复发的独立危险因素（P=0.009、<0.001、=0.001、=0.005）。 结论PTC恶性超声特征越多，其复发可能性越大，其中TI-RADS 4c~5是PTC复发的独立危险因素。此外，肿瘤囊性变、肿瘤大小、颈部淋巴结转移均有助于预测肿瘤预后。

Preoperative ultrasonographic characteristics and risk factors for postoperative recurrence of thyroid papillary carcinoma

ObjectiveTo analyze the preoperative ultrasonographic characteristics and risk factors for postoperative recurrence of papillary thyroid carcinoma (PTC) . MethodsA total of 320 patients with thyroid papillary carcinoma admitted to Xuanwu Hospital from January 2015 to December 2018 were selected. According to follow-up results, the patients were divided into either a recurrence group (n=292) or a non-recurrence group (n=28). Data including gender, age, tumor composition, ultrasound characteristics (echo, boundary, morphology, microcalcification, long-to-short dimension ratio, TI-RADS 4a-4b, and TI-RADS 4c-5), and pathological features (size of lesion, multifocal lesions, extra-membranous invasion, cervical lymph node metastasis, and surgical methods) were recorded. The risk factors for postoperative recurrence were identified, and the correlation between postoperative recurrence of thyroid papillary carcinoma and preoperative ultrasonic characteristics was analyzed. ResultsAmong the 320 patients included, 28 (8.75%) had recurrence. Univariate analysis showed that TI-RADS 4c-5, tumor cystic degeneration, tumor boundary, long-to-short dimension ratio, tumor size, cervical lymph node metastasis, and surgical method were risk factors for PTC recurrence (P<0.001, <0.001, =0.002, =0.006, =0.003, <0.001, and =0.035, respectively). Multivariate Cox proportional risk analysis demonstrated that TI-RADS 4c-5 (P=0.009), tumor cystic degeneration (P<0.001), tumor size (P=0.001), and cervical lymph node metastasis (P=0.005) were independent risk factors for recurrence. ConclusionMore malignant ultrasound features of PTC suggest a greater possibility of recurrence. TI-RADs 4c-5 is an independent risk factor for recurrence in PTC patients. Cystic degeneration, tumor size, and cervical lymph node metastasis are predictive factors for PTC recurrence.