cN0甲状腺乳头状癌中央区淋巴结转移的危险因素分析  

Clinical risk factors for central compartment lymph node metastasis in papillary thyroid cancer（cNO）

作　　者：俞甲子[1] 王雅平[1] 贝一冰 华鲁纯[1] 

机构地区：[1]复旦大学附属华山医院普外科,上海200040

出　　处：《中华普通外科杂志》2014年第3期195-198,共4页Chinese Journal of General Surgery

摘　　要：目的研究术前临床检查颈部淋巴结阴性（cN0）甲状腺乳头状癌（PTC）患者发生Ⅵ区淋巴转移的危险因素及临床意义。方法回顾性分析2008年1月-2012年12月在复旦大学附属华山医院行甲状腺癌根治性切除＋中央区淋巴结（CCLN）清扫术的272例cNOPTC患者临床资料。根据术后病理检查分为淋巴结转移组（115例）和淋巴结未转移组（157例），应用χ^2检验、秩和检验和多因素logistic回归模型对危险因素进行统计分析。结果甲状腺乳头状微灶癌及非微灶乳头状癌CCLN转移率分别为34．9％、48．3％，单因素分析发现肿瘤直径（χ^2=10．26，P〈0．01）、单侧癌灶部位（χ^2=13．87，P〈0．01）、包膜侵犯（χ^2=20．19，P〈0．01）、单侧多灶性PTC（χ^2=7．42，P〈0．01）及非微灶癌（χ^2=5．12，P〈0．05）与淋巴结转移显著相关；多因素logistic回归模型分析显示肿瘤位于甲状腺中部或下极、侵犯包膜、单侧多发癌灶为PTC患者CCLN转移的独立危险因素。结论cN0PTC有较高的CCLN转移率，对PTC患者清扫中央区的淋巴结是十分必要的。Objective To analyze the risk factors of central compartment lymph node （CCLN） metastasis in papillary thyroid carcinoma（PTC） without clinically suspected cervical lymph node metastasis （oN0）. Methods Clinical data of 272 PTC （cN0） patients who underwent radical thyroidectomy and CCLN dissection between January 2008 and December 2012 in Huashan hospital were retrospectively analyzed. Patients were divided into CCLN positive group （115 cases）and CCLN negative group（ 157 cases） according to postoperative pathology. Chi-square test, wilcoxon test and multivariate logistic regression analysis were used to analyze risk factors. Results CCLN metastasis of papillary micro thyroid cancer （PMTC） and papillary thyroid cancer（PTC） was 34. 9% and 48.3%, respectively. Tumor size（X^2 = 10. 26,P 〈0. 01）, position（X^2 = 13.87, P〈0. 01）, capsular invasion（ X2 =20. 19,P 〈0. 01 ）, multifocal PTC（X^2 =7.42,P 〈 0.01 ） andunmlero-carcmoma（ X^2 = 5.12,P 〈 0. 05） were significantly correlated to lymph node metastasis. Middle area or lower pole of thyroid carcinoma, capsular invasion and muhifocal PTC were independent risk factors of CCLN metastasis in PTC. Conclusions The eN0 PTC has a high rate of pathological CCLN metastasis, it is imperative to conduct thyroidectomy with ipsilateral level CCLN dissection in PTC patients.

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]