甲状腺微小乳头状癌颈部淋巴结转移危险因素分析

目的 回顾性研究甲状腺微小乳头状癌（PTMC）颈部淋巴结转移的危险因素。方法 收集2010年1月—2020年3月西安交通大学第一附属医院耳鼻咽喉头颈外科收治的1 363例PTMC患者的临床资料，分析其性别、年龄、肿瘤直径、多灶性、腺外侵犯（ETE）、肿瘤侧别、颈淋巴结转移、BRAF^V600E突变与颈淋巴结转移的关系。结果 单因素分析显示男性、年龄<55岁、肿瘤直径>5 mm、多灶ETE、双侧癌灶与PTMC颈部淋巴结转移相关（P均<0.05）；进一步统计分析显示男性、年龄<55岁、肿瘤直径>5 mm、多灶、ETE、双侧癌灶患者易发生中央区淋巴结转移（P均<0.05）；男性、多灶、ETE、双侧癌灶患者更易发生颈侧区淋巴结转移（P<0.05）。Logistic回归分析显示男性、年龄<55岁、肿瘤直径>5 mm、多灶和ETE是PTMC颈部淋巴结转移的独立危险因素（P均<0.05）；进一步统计分析显示其同时也是中央区淋巴结转移的独立危险因素（P<0.05）；而颈侧区淋巴结转移的独立危险因素为男性、多灶和ETE（P均<0.05）。结论 PTMC患者如果同时存在男性、年龄<55岁、肿瘤直径>5 mm、多灶和ETE等淋巴结转移危险因素时，建议常规行中央区颈淋巴结清扫术，同时结合术前颈部B超或增强CT结果，考虑行选择性颈侧区淋巴结清扫，降低肿瘤复发再次手术的风险；其余PTMC患者可建议定期复查甲状腺B超密切随诊。

Analysis of risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma

Objective To explore the risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC). Methods Clinical data of 1 363 PTMC patients were treated surgically from Jan.2010 to Mar.2020 the First Affiliated Hospital of Xi''an Jiaotong University,otolaryngology head and neck. The clinicopathological features between the two groups,including patients'' gender and age, tumor size, multiple foci, extrathyroidal extensive (ETE), tumor location, cervical lymph node metastasis, as well as the relationship between BRAF^V600E mutation and cervical lymph node metastasis, were compared and analyzed. Results Univariate analysis showed that cervical lymph node metastasis was associated with male gender, age <55 years old, tumor diameter >5 mm, multiple foci,ETE and bilateral cancer (all P<0.05). Further analysis showed that central lymph node metastasis was most likely to occur in patients with male gender, age <55 years old, tumor diameter >5 mm, multiple foci, ETE, bilateral cancer (all P<0.05). Male patients with multiple foci, ETE and bilateral cancer were prone to lateral lymph node metastasis (all P<0.05). Logistic regression analysis showed that male gender, age <55 years old, tumor diameter >5 mm, multiple foci and ETE were independent risk factors for both cervical lymph node metastasis (all P<0.05) and central lymph node metastasis (all P<0.05). However, the independent risk factors for lateral lymph node metastasis were male gender, multiple foci and ETE (all P<0.05). Conclusions In PTMC patients with risk factors for lymph node metastasis such as male gender, age <55 years old, tumor diameter >5 mm, multifoci and ETE, preventive dissection of central lymph node should be routinely performed, and selective lateral lymph node dissection should be considered in combination with preoperative cervical B ultrasonography or enhanced computed tomography to reduce the risk of recurrence.Periodic B ultrasound thyroid examination and close follow-up are recommended for other PTMC patients.