cN0单侧叶甲状腺乳头状癌对侧中央区淋巴结转移的相关危险因素分析

目的分析cN0单侧叶甲状腺乳头状癌对侧中央区淋巴结转移的相关临床及超声危险因素。 方法回顾性选取2013年1月至2015年12月于北京协和医院经术后病理证实为甲状腺乳头状癌的患者4265例，纳入双侧甲状腺叶切除＋双侧中央区淋巴结清扫的临床颈部淋巴结阴性（cN0）的单侧甲状腺乳头状癌患者265例。所有患者术前均行常规超声检查。以病理结果为金标准，分析对侧中央区淋巴结转移组与无对侧中央区淋巴结转移组相关临床资料及超声测量指标的差异。将单因素分析有统计学意义的变量纳入Logistic多因素分析，得出cN0单侧叶甲状腺乳头状癌对侧中央区淋巴结转移的独立危险因素。 结果265例cN0患者中28.3%（75/265）出现对侧中央区淋巴结转移。单因素分析结果显示，Cont-CLNs转移组较非转移组发生微钙化的比例更高（84.1% vs 53.2%），病灶更大（69.3% vs 51.6%），病理被膜受侵率更高（82.6% vs 61.5%），单发病灶比例更高（43.1% vs 25.9%），患者年龄更小（90.7% vs 78.9%），2组比较差异均有统计学意义（χ²=20.306、6.901、6.775、7.197、5.062，P<0.001、-0.009、0.009、0.007、0.024）。然而性别、结节的囊实性、内部回声、血流以及是否伴有桥本甲状腺炎的差异与无Cont-CLNs转移组比较，差异无统计学意义（P均>0.05）。进一步行Logistic多因素分析发现，微钙化（OR=3.768，P=0.003）及被膜受侵（OR=2.673，P=0.042）是对侧中央区淋巴结转移的独立危险因素。 结论微钙化及病理被膜受侵是cN0单侧叶甲状腺乳头状癌患者发生Cont-CLNs转移的独立危险因素，其可为cN0患者中央区淋巴结清扫方案的制定提供一定的参考信息，以期减少肿瘤复发及远处转移，提高患者生存率及生活质量。

Risk factors for contralateral central lymph node metastasis in unilateral cN0 papillary thyroid carcinoma

ObjectiveTo identify the risk factors for predicting contralateral central lymph node metastasis (CCLNM) in unilateral cN0 papillary thyroid carcinoma (PTC). MethodsA total of 4265 patients with PTC confirmed by pathology at Peking Union Medical College Hospital from January 2013 to December 2015 were retrospectively analyzed, of whom 265 with unilateral cN0 PTC who underwent bilateral resection and bilateral central area dissection were included in this study. All patients were examined by ultrasonography before operation. Pathological results were used as the gold standard to analyze the differences of relevant clinical data and ultrasonic measurement indexes between the contralateral and non-contralateral central lymph node metastasis groups. Variables with statistical significance in univariate analysis were included into multivariate logistic analysis to identify independent risk factors for CCLNM in unilateral cN0 PTC. ResultsAmong the 265 patients, 28.3% had CCLNM. In the univariate analysis, microcalcification (84.1% vs 53.2%, χ²=20.306, P<0.001), larger lesions (69.3% vs 51.6%, χ²=6.901, P=0.009), pathological capsule invasion (82.6% vs 61.5%, χ²=6.775, P=0.009), fewer lesions (43.1% vs 25.9%, χ²=7.197, P=0.007), and younger age (90.7% vs 78.9%, χ²=5.062, P=0.024) were associated with CCLNM in PTC patients. However, there were no significant differences in gender, component, internal echo, blood flow, or Hashimoto's thyroiditis (P>0.05). Multivariate logistic analysis showed that microcalcification (OR=3.768, P=0.003) and pathological capsule invasion (OR=2.673, P=0.042) were independent risk factors for CCLNM. ConclusionThe CCLNM rate in cN0 unilateral PTC patients with microcalcification and pathological capsule invasion is higher than that of patients without. These findings may be useful for identifying patients at higher CCLNM risk, so as to reduce tumor recurrence and distant metastasis, and improve the survival rate and quality of life of patients.