甲状腺乳头状癌中桥本甲状腺炎与颈部中央区淋巴结转移的关系  

The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in papillary thyroid carcinoma

作　　者：孙文文[1] 李秧秧[1] 钟申[2] 蔡业丰 王青煊[2] 李权[2] 张筱骅[2] 杨开颜[1] 

机构地区：[1]温州医科大学附属第一医院病理科,325000 [2]温州医科大学附属第一医院肿瘤外科,325000

出　　处：《中华内分泌代谢杂志》2016年第11期906-909,共4页Chinese Journal of Endocrinology and Metabolism

基　　金：国家863高技术研究发展计划（2012AA02A210）

摘　　要：目的：探讨在甲状腺乳头状癌（ papillary throid carcinoma, PTC）患者中,合并桥本甲状腺炎（ Hashimoto′s thyroiditis, HT）对颈部中央区淋巴结转移（ central lymph node metastasis, CLNM）的影响。方法回顾性分析179例行甲状腺全切和中央区淋巴结清扫术的PTC患者的临床病理资料。收集术前超声特征（包括边界、结节组成、钙化、血管化、纵横比）；收集术后病理报告以明确肿瘤大小、结节数目、是否合并HT以及淋巴结转移情况,及患者性别、年龄等临床资料。结果179例 PTC 患者中合并 HT 患者有51例（28.5%）,出现CLNM的患者有98例（54.7%）,合并 HT 的患者肿瘤直径更小（≤10 mm 对〉10 mm：38.8%对16.0%, P=0.001）、结节多为单发（39.2%对21.0%, P=0.008）、较少出现Ⅵ区淋巴结转移（20.4%对38.3%, P=0.008）、纵横比多〉1（37.6%对20.2%, P=0.01）、腺内播散较多（54.5%对24.8%, P=0.004）、腺外脏器侵犯较少（5.1%对35.0%, P〈0.01）。多因素分析表明：在调整年龄、性别、肿瘤大小等因素的影响后,HT的存在可降低PTC患者CLNM的发生率（OR=0.34,95%CI 0.151~0.765, P=0.009）。结论甲状腺乳头状癌合并HT患者CLNM发生率较低。Objective To explore the effect of Hashimoto′s thyroiditis （ HT ） on central lymph nodal metastasis （ CLNM） in papillary thyroid carcinoma （ PTC） patients. Methods A retrospective study of 179 patients who underwent thyroidectomy with nodal excision and with nodal excision for PTC were enrolled. The data of preoperative ultrasound diagnosis, nodule composition, calcification, vascularization, tall-to-wide ratio, and pathologic characteristics were collected, as well as their postoperative findings such as tumor size, number of nodule, with or without HT, and lymph node metastasis. Results There were 51 patients （ 28. 5%） with HT and 98 （54. 7%） with CLNM. The tumor size of patients with HT was smaller （≤10 mm vs〉10 mm：38. 8% vs 16. 0%, P=0. 001）, patients with HT have decreased possibility of CLNM （20. 4% vs 38. 3%, P=0. 008）, more chance with single nodule than multi-nodules（39. 2% vs 21. 0%, P=0. 008）, more probability to be longitudinal than horizontal （37. 6% vs 20. 2%, P=0. 01）, more often to have intra-gland dissemination （54. 5% vs 24. 8%, P=0. 004）, and less chance to have gland invasion （5. 1% vs 35. 0%, P〈0. 01）. Multivariate analysis showed that, adjusted factors such as age, sex, and tumor size, the presence of HT would reduce CLNM in PTC （ OR=0. 34, 95% CI 0. 151-0. 765, P=0. 009）. Conclusion The incidence of CLNM seems to be lower in PTC combined HT patients.

关 键 词：甲状腺乳头状癌 桥本甲状腺炎 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]