甲状腺微小乳头状癌颈侧区淋巴结转移相关因素分析  

Predicting factors for lateral lymph node metastasis in papillary thyroid microcarcinoma

作　　者：邵选 林快鹿[2] 张筱骅[2] 

机构地区：[1]医学院温州市第三临床学院肿瘤外科,温州325000 [2]温州医学院附属第一医院肿瘤外科

出　　处：《中国综合临床》2011年第7期739-742,共4页Clinical Medicine of China

摘　　要：目的分析甲状腺微小乳头状癌（PTMC）的相关因素与颈侧区淋巴结转移之间的关系。方法回顾性分析2002年1月至2009年12月我院收治的行改良颈清扫术PTMC患者77例，探讨与PTMC相关的因素。结果77例PTMC患者中颈侧区淋巴结转移率为39％（30／77）。单因素分析发现年龄、肿瘤侵犯被膜外组织和发生中央区淋巴结转移、血小板计数和肿块与甲状腺被膜的接触部分超过肿块周长25％、肿块位置均与是否发生颈侧区淋巴结转移有显著相关性（统计值分别为：2．425、6．392、12．584、2．143、8．755、6．89，P均〈0．05）。多因素分析Logistic回归模型发现年龄、中央区淋巴结转移、B超肿块位置为预测颈侧区淋巴结转移的独立预测因子[相对危险度分别为0．942（95％C10．889-0．998）、4．396（95％CI1．241-15．573）和4．436（95％CI1．194-16．482），P值分别为0．042、0．022、0．026]。结论年龄、中央区淋巴结转移以及肿块位于上极位置与颈侧区淋巴结转移有密切的相关性。对于年轻甲状腺微小癌患者，肿块位于上级且伴有中央淋巴结转移，应予以更积极的治疗方法以及术后的密切随访。Objective To determine the predictive factors for lateral lymph node metastasis （LNM） in papillary thyroid microcarcinoma （PTMC）. Methods From January 2002 to December 2009,77 patients with PTMC were treated by modified radical neck dissection. We analyzed the association between lateral LNM and clinical factors, US features, hematological parameters and pathologic features of PTMC. Results The rate of lateral LNM was 39% in 77 PTMCs （30/77）. We found a statistically significant association between lateral LNM and age, pathologic features （extrathyroid invasion and central LNM ）, higher platelet counts and US features of PTMC （upper pole location,contacting area of the tumor with the capsule of throid gland 〉 25% of the perimeter of the tumor） in univariate analysis （statistic values were 2. 425,6. 392,12. 584,2. 143,8. 755 and 6.89, respectively,Ps 〈 0.05 ）. Age, pathologic features （ central LNM） and US features of PTMC （ upper pole location） were found to he independent predictive factors for lateral LNM in multivariate analysis （ OR and 95% CI was 0. 942 （0. 889 - 0.998）, 4. 396 （ 1. 241 - 15. 573 ） and 4. 436 （ 1. 194 - 16. 482）, P was 0. 042, 0. 022 and 0.026, respectively）. Conclusion In patients with PTMC, independent factors in predicting lateral LNM were age, US features of PTMC （ upper pole location） and pathologic features （ central LNM ）. These patients should receive relatively aggressive initial treatments and vigilant follow-up.

关 键 词：甲状腺肿瘤 甲状腺微小乳头状癌 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]