甲状腺乳头状癌伴对侧腺叶结节患者合并隐匿癌的危险因素分析  

Prediction of occult carcinoma in contralateral nodules for unilateral papillary thyroid carcinoma

作　　者：万汉锋[1] 张彬[1] 鄢丹桂[1] 徐震纲[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院肿瘤研究所头颈外科,100021

出　　处：《中华耳鼻咽喉头颈外科杂志》2014年第11期881-884,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：协和青年基金及中央高校基本科研业务费专项资金（3332013030）

摘　　要：目的 分析单侧甲状腺乳头状癌患者对侧隐匿癌比例及相关影响因素.方法 回顾性分析2011年1月至2013年12月通过超声、细针抽吸细胞学等检查诊断为单侧甲状腺乳头状癌合并对侧良性结节157例连续病例的资料,全部患者行甲状腺全切＋颈淋巴清扫手术,分析对侧甲状腺隐匿癌检出比例及相关影响因素.结果 157例单侧甲状腺乳头状癌患者中68例（43.3％）合并对侧甲状腺乳头状癌,隐匿癌最大径0.1 ～1.2 cm,其中≤0.5 cm 56例,0.5～1.0 cm9例,1.0～1.2 cm3例.单因素分析发现对侧甲状腺隐匿癌与年龄（x^2 =7.266,P=0.007）,病理检出同侧多灶（x^2=5.090,P=0.024）相关,而与性别、家族史、同侧肿瘤大小、甲状腺功能、桥本甲状腺炎、肿瘤侵犯腺体外、超声检出同侧多灶、有无淋巴结转移等因素均无相关性.多因素Logistic回归分析发现年龄（OR=1.054,P=0.001）与病理检出同侧多灶（OR=2.443,P=0.021）是对侧甲状腺隐匿癌的独立危险因素.结论 在单侧甲状腺乳头状癌伴对侧甲状腺结节的病例中,对侧甲状腺同时合并隐匿癌的现象较为常见,尤其是对于年轻、同侧甲状腺多发癌灶的患者需要警惕.Objective To investigate the risks for occult carcinoma in contralateral nodules for unilateral papillary thyroid carcinoma.Methods The study included 157 consecutive cases of unilateral papillary thyroid carcinoma with benign nodules in the contralateral lobe identified by preoperative ultrasound or fine-needle aspiration from January 2011 to December 2013.The patients received total thyroidectomies and neck lymph node dissections.The frequency and predictive factors for contralateral occult carcinoma in these patients were analyzed.Results A total of 68 patients （43.3%） had occult papillary thyroid carcinoma in the contralateral lobe and the maximum diameter of contralateral occult papillary carcinoma ranged from 0.1 to 1.2 cm,including ≤0.5 cm in 56 patients,0.5-1.0 cm in 9 patients and 〉 1.0 cm in 3 patients respectively.In univariate analysis,occult carcinoma in the contralateral lobe was associated with patient age （x^2 =7.266,P =0.007） and pathologically multifocality in the ipsilateral lobe （x^2 =5.090,P =0.024）,but not with family history,tumor size,thyroid function,Hashimoto＇s thyroiditis,perithyroidal invasion,multifocality in the ipsilateral lobe,clinically or pathologically node-negative neck.In multivariate Logistic an analysis,age（OR =1.054,P =0.001） and multifocality in the ipsilateral lobe on final pathology （OR =2.443,P =0.021） were independent predictive factors for contralateral occult papillary thyroid carcinoma.Conclusions Occult carcinoma is common in the contralateral ＂benign＂ nodules in patients with unilateral papillary thyroid carcinoma especially in young patients or the cases with multifocal tumors.

关 键 词：甲状腺肿瘤 癌 乳头状 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]