cN0甲状腺乳头状癌中央区淋巴结转移规律及危险因素分析

目的 分析临床颈淋巴结阴性(cN0)单侧甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患侧及对侧中央区淋巴结转移(central lymph node metastasis,CLNM)的规律及危险因素.方法 回顾性分析2014年6月至2015年8月我科收治的46例cN0单侧PTC患者的临床病理资料,包括性别、年龄、癌灶数量、肿瘤直径、腺外浸润情况、是否合并桥本甲状腺炎(Hashimoto thyroiditis,HT)、T分期等,总结cN0单侧PTC患者患侧及对侧CLNM的规律,并应用x2检验和多元logistic回归模型分析其危险因素.结果 患侧及对侧CLNM发生率分别为32.6％(15/46)和21.7％(10/46),在对侧转移的患者中,仅对侧发生CLNM者占70.0％(7/10).其中T1、T2期患者共发生CLNM 20例(48.8％,20/41).单因素分析表明,年龄＜45岁、肿瘤直径＞1 cm、不合并HT与患侧CLNM有关(P＜0.05),所有临床病理因素均与对侧CLNM无关(P＞0.05).多因素分析表明,肿瘤直径＞1 cm(OR=4.890,P=0.044)是患侧CLNM的独立危险因素,而合并HT(OR=0.086,P=0.034)是患侧CLNM的保护因素;多灶癌(OR=7.60,P=0.038)是对侧CLNM的独立危险因素.在仅发生患侧CLNM和仅发生对侧CLNM的患者中,合并HT时更易发生对侧CLNM(P＜0.05).结论 在cN0单侧PTC患者中,患侧CLNM最为常见,也可仅发生对侧CLNM;T1、T2期患者CLNM率较高,建议行预防性中央区淋巴结清扫(prophylactic central lymph node dissection,PCND);肿瘤直径＞1 cm时,建议行患侧PCND;肿瘤为多灶癌、合并HT时,行对侧PCND价值更大.

Patterns and predictive factors of central lymph node metastasis in cN0 papillary thyroid carcinoma

Objective To evaluate the patterns and predictive factors of ipsilateral and contralateral central lymph node metastasis (CLNM) in the unilateral papillary thyroid carcinoma (PTC) patients with clinically node-negative neck (cN0). Methods We retrospectively reviewed the clinicopathological characteristics of 46 patients with cN0 unilateral PTC, including gender, age, multiplicity, tumor size, extrathyroidal extension, Hashimoto thyroiditis (HT), and T stage. Chi-square test and logistic regression were used to evaluate the patterns and predictive factors of ipsilateral and contralateral CLNM in cN0 unilateral PTC patients. Results Ipsilateral CLNM and contralateral CLNM were present in 32.6%(15/46) and 21.7% (10/46) of the patients, respectively. In patients with contralateral CLNM, 70.0% (7/10) had isolated contralateral CLNM without ipsilateral CLNM. Twenty patients of the 41 (48.8%) with T1/T2 stage had CLNM. Univariate analysis showed that tumor size >1 cm, age <45 years and absence of HT were associated with ipsilateral CLNM (P<0.05). None of the above clinicopathological characteristics was associated with contralateral CLNM. Multivariate analysis showed that tumor size >1 cm (OR=4.890, P=0.044) was the independent predictor of ipsilateral CLNM, and HT (OR=0.086, P=0.034) was a protective factor of ipsilateral CLNM. Multifocal cancer was an independent predictor of contralateral CLNM (OR=7.60, P=0.038). Compared with isolated ipsilateral CLNM, contralateral CLNM occured more often in patients with HT (P<0.05). Conclusion Ipsilateral CLNM is the most frequent in cN0 unilateral PTC patients and contralateral CLNM may independently occurr without ipsilateral CLNM. CLNM is frequent in patients at T1/T2 stage and prophylactic central lymph node dissection (PCND) is suggested for these patients. Ipsilateral PCND should be considered in patients with a tumor size >1 cm, while contralateral PCND may be more valuable for patients with multifocal cancer or HT.