甲状腺乳头状癌患者中央区淋巴结转移的危险因素分析  

Risk factors of the central lymph node metastasis in papillary thyroid carcinoma

作　　者：刘南[1] 聂春磊[1] 张杰武[1] 

机构地区：[1]哈尔滨医科大学附属第三医院甲状腺外科,150040

出　　处：《中华地方病学杂志》2015年第5期340-343,共4页Chinese Journal of Endemiology

摘　　要：目的 分析甲状腺乳头状癌（PTC）患者中央区淋巴结（CLN）转移的相关危险因素,为临床采用手术治疗方式提供依据.方法 通过回顾性调查,分析哈尔滨医科大学附属第三医院甲状腺外科2010年1月至2012年6月初治的407例PTC患者临床病历资料.调查内容包括患者的一般情况,甲状腺特异性抗体,家族病遗传史,病理特征（癌灶直径、癌灶数量、肿瘤部位、浸润被膜）,肿瘤TNM分期与CLN转移等.用x2检验进行单因素分析,并用Logistic回归对单因素分析中有统计学意义的指标进行多因素分析.结果 共调查407例PTC患者,CLN转移率为51.351％（209/407）.单因素分析显示,PTC患者CLN转移与性别、甲状腺特异性抗体、家族病遗传史、肿瘤部位无明显相关性（x2=1.457、1.106、0.000、0.260,P均＞0.05）;与年龄、癌灶数量、癌灶直径、浸润被膜情况、肿瘤TNM分期明显相关（x2=21.080、14.974、47.671、12.858、8.765,P均＜0.01）.多因素分析显示,年龄（＜ 45岁）、癌灶直径（≥1.0 cm）、多发癌灶及肿瘤分期（T3＋ T4）是CLN转移的危险因素[比值比（OR）=0.937、2.347、0.380、0.389,P均＜0.01].结论 PTC患者年龄（＜45岁）、癌灶直径（≥1.0 cm）、多发癌灶、肿瘤分期（T3＋ T4）是CLN转移的危险因素.若相关危险因素存在,应该常规进行CLN清扫.Objective To study the risk factors of central lymph node （CLN） metastasis in papillary thyroid carcinoma （PTC）,to provide the basis for clinical treatment.Methods A total of 407 patients with PTC in thyroid surgery,the Third Affiliated Hospital of Harbin Medical University from January 2010 to June 2012 who had undergone at least ipsilateral CLN were studied.These factors included normal situation,thyroidglobulin antibody or thyroid microsomal antibody,family history,pathological features （the size of primary,tumor multifocal,tumor location and capsular invasion）,TNM staging and CLN metastasis.Univariate analysis and multivariate analysis were performed using x2 test and binary Logistic regression test,respectively.Results The CLN metastasis rate was 51.351% （209/407） of the 407 patients with PTC.The CLN metastasis was significantly associated with age,tumor multifocal,the size of primary tumor,capsular invasion and TNM （x2 =21.080,14.974,47.671,12.858,8.765,all P 〈 0.01）.Sex,thyroid globulin antibody or thyroid microsomal antibody,family history and tumor location were not associated with CLN metastasis （x2 =1.457,1.106,0.000,0.260,all P 〉 0.05）.Multivariate analysis indicated that age （〈 45 year）,the size of primary tumor （≥ 1.0 cm）,tumor-muhifocal,and TNM （T3 ＋ T4） were the independent risk factors for CLN metastasis [odds ratio （OR） =0.937,2.347,0.380,0.389,all P 〈 0.01].Conclusions Age （〈 45 year）,the size of primary tumor （≥ 1.0 cm）,tumor-multifocal and TNM （T3 ＋ T4） are risk factors for CLN metastasis in PTC.Dissection of CLN should be considered for PTC patients with these factors.

关 键 词：甲状腺 癌 乳头状 淋巴结 淋巴转移 

分 类 号：R736.1[医药卫生—肿瘤]