cN0期甲状腺乳头状微小癌中央区淋巴结转移的多因素Logistic回归分析  

Risk Factors for Central Compartment Lymph Node Metastasis in Papillary Thyriod Microcarcinoma

作　　者：邱凯[1] 林梃[1] 江珊[1] 

机构地区：[1]福建医科大学附属协和医院血管与甲状腺外科,福建福州350001

出　　处：《武汉大学学报（医学版）》2015年第4期558-561,共4页Medical Journal of Wuhan University

摘　　要：目的:探讨影响cN0期甲状腺乳头状微小癌(PTMC)中央区淋巴结转移的高危因素,为患者的临床治疗及其预后提供科学的依据。方法:病例来源于我院甲状腺外科2011-2013年期间临床诊断为cN0PTMC的患者199例,对其临床资料与中央区淋巴结转移的关系进行Logistic回归分析。结果:共纳入的研究对象中发生中央区淋巴结转移者共88例,转移率为44.22%,其中多病灶患者中央淋巴转移率为47.27%。侵犯被膜患者的淋巴转移率为50.49%;以纳入标准为0.1,剔除标准为0.15对cN0期PTMC患者进行单因素Logistic回归分析,发现性别(OR=2.919,95%CI:1.36-6.27)、年龄(OR=0.423,95%CI:0.24-0.76)、癌灶直径(OR=1.94,95%CI:1.26-2.98)、有无侵犯被膜(OR=1.70,95%CI:0.97-2.99)均与中央区淋巴结转移有显著相关性(P<0.01)。将性别、年龄分组、癌灶直径分组、被膜有无侵犯等因素纳入Logistic多因素回归模型,发现性别为女性、癌灶直径越大可能为cN0期甲状腺乳头状微小癌发生中央区淋巴结转移的危险因素,而年龄小于45岁是其保护因素。结论:cN0期PTMC患者的中央区转移率较高,尤其有被膜浸润的患者更为突出。对于癌灶直径大于0.8cm、年龄大于45岁或存在被膜浸润的患者应行患侧甲状腺切除术加同侧中央区淋巴结清扫术;而对于不具备上述高危因素的患者建议保守治疗,其对患者预后的生存率没有太大影响。Objective： To explore the risk factors of lymph node in cN0 papillary thyriod microcarci- noma, and to provide scientific basis for the clinical treatment and prognosis of patients. Methods： A total of 199 cases who had been diagnosed PTM were selected from our surgical on- cology during 2011 to 2013, including 41 cases in 2011, 81 cases in 2012 and 79 cases in 2013. Results. In these cases, the central region lymph node metastasis occurred in 88 cases with metas- tasis rate of 44.22%, and multiple lesions patients showed central lymphatic metastasis rate of 47.27%. Capsule infiltration patients showed lymphatic metastasis rate of 50.49%. Single logis- tic regression analysis showed that gender （OR= 2. 919, 95 % CI. 1.36-6.27）, age （OR=0. 423, 95% CI. O. 24-0.76）, tumour diameter （OR=1. 94, 95% CI. 1.26-2.98） ,with or without infil-tration of capsule （OR = 1.70, 95% CI.0. 97-2. 99） were significantly correlated with central lymph node metastasis （P〈0.01）. We took the above elements into the Logistic regression mod- el, and found that women with bigger tumour diameter had greater risk for cN0 thyroid papillary microcarcinoma. Conclusion. The transfer rate for patients with cN0 PTMC is higher, especially pa- tients with capsule invasion. For the patients over 45 years old whose tumour diameter was bigger than 0.8 cm, or with capsule infiltration, bilateral thyroidectomy plus ipsilateral lymph node excision in cen- tral region are recommended, while for those without those high risk factors, conservative treatment is recommended, for the outcome will not much affect the survival rate of patients.

关 键 词：甲状腺乳头状微小癌 淋巴转移 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]