甲状腺微小乳头状癌中央区淋巴结转移的相关因素分析

目的 回顾性分析甲状腺微小乳头状癌(PTMC)患者的临床资料,探讨PTMC患者发生中央区淋巴结转移(CLNM)的相关因素,为预防性中央组淋巴结清扫提供临床依据。 方法 纳入2013年1月-2016年6月蚌埠医学院第一附属医院肿瘤外科手术治疗并病理证实为PTMC的254例患者,按有无CLNM分成转移组和无转移组。收集患者临床资料,分析年龄、性别、癌灶数、病灶直径、术前超声提示微钙化和肿大淋巴结情况与PTMC患者发生CLNM的相关性。 结果 254例PTMC患者中77例发生CLNM,发生率为30.3%。分析显示男性、年龄<45岁、病灶最大径 ≥ 5 mm、多发病灶及术前超声提示淋巴结肿大的PTMC患者CLNM发生率明显高于女性、年龄 ≥ 45岁、病灶最大径<5 mm、单发病灶及无淋巴结肿大患者(均P<0.05)。分析显示术前超声提示有微钙化的PTMC患者CLNM发生率与无微钙化患者相当,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示男性、原发病灶直径 ≥ 5 mm、多发病灶及术前超声提示颈部淋巴结肿大是PTMC患者颈部中央区淋巴结转移的独立危险因素(均P<0.05)。 结论 PTMC患者为男性、年龄<45岁、病灶最大径 ≥ 5 mm、多发病灶及术前颈部超声提示淋巴结肿大的更易发生CLNM。其中男性、原发病灶直径 ≥ 5 mm、多发病灶及术前超声提示颈部淋巴结肿大PTMC患者颈部中央区淋巴结转移的独立危险因素。 

Risk factors of central lymph node metastasis in patients with papillary thyroid microcarcinoma

Objective To analyze the clinical characteristics of patients with papillary thyroid microcarcinoma (PTMC), and explore risk factors of central lymph node metastasis (CLNM)in patients with PTMC. Methods A total of 254 patients with PTMC from January, 2013 to June, 2016 were analyzed retrospectively, all subjects underwent central compartment lymph node dissection. The patients were assigned into positive group and negative group according to the CLNM. The risk factors for CLNM were analyzed with respect to sex, age, tumor size, tumor multifocal, microcalcification, lymphadenectasis of lateral neck. Results Among the 254 patients, the CLNM occurred in 77 patients (30.3%). The univariate analyses showed that gender of male, age of <45 years, tumor diameter ≥ 5 mm, multifocality and lymphadenectasis of lateral neck significantly increased the risk of CLNM (all P<0.05). Nevertheless, the microcalcification was not significantly related to the presence of CLNM (P>0.05). Multivariate analysis showed that gender of male, tumor diameter ≥ 5 mm multifocality, and lymphadenectasis of lateral neck were independent risk factors for central lymph node metastasis (all P<0.05). Conclusion The gender of male, age of <45 year, tumor diameter ≥ 5 mm, multifocality and lymphadenectasis of lateral neck are associated with CLNM in PTMC patients. The male patients with primary lesions ≥ 5 mm in diameter, multiple lesions and preoperative ultrasound findings of cervical lymphadenopathy are the independent risk factors for CLNM in patients with PTMC.