甲状腺乳头状癌合并Graves病淋巴结转移癌的高危因素分析  

Risk Factors of Lymphnode Metastasis in Patients with Thyroid Papillary Carcinoma Associated with Graves Disease

作　　者：谢勇[1] 刘跃武[1] 王梦一[1] 王文泽[2] 刘洪沨[1] 李小毅[1] 高维生[1] XIE Yong LIU Yue-wu WANG Meng-yi WANG Wen-ze LIU Hong-feng LI Xiao-yi GAO Wei-sheng(Department of GeneralSurgery Department of Pathology, PUMC Hospital, CAMS and PUMC, Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院基本外科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院病理科,北京100730

出　　处：《中国医学科学院学报》2016年第5期554-558,共5页Acta Academiae Medicinae Sinicae

摘　　要：目的总结甲状腺乳头状癌合并Graves病患者相关淋巴结转移癌的特征以及对预后的影响,为临床治疗提供依据。方法 2004年1月至2013年12月在北京协和医院收治的甲状腺乳头状癌合并Graves病的患者98例,根据有无淋巴结转移分为淋巴结转移阳性组（n=34）和淋巴结转移阴性组（n=64）,对两组患者的一般情况、血生化指标、病理结果和预后进行比较。结果两组患者在性别（χ~2=0.2113,P=0.6458）、年龄（t=1.7000,P=0.0922）、肿瘤直径（t=1.2559,P=0.2122）、是否为多灶肿瘤（χ~2=1.9170,P=0.1661）等方面差异均无统计学意义。淋巴结转移阳性组的中位促甲状腺激素受体抗体（TR-Ab）水平为4.84 U/L,明显高于阴性组的2.99 U/L（t=2.0169,P=0.0465）;两组患者在血清促甲状腺激素（t=0.0257,P=0.9800）、游离三碘甲状腺原氨酸（t=1.3610,P=0.1770）、游离甲状腺素（t=0.0082,P=0.9930）、甲状腺过氧化物酶抗体（t=0.0177,P=0.9860）和甲状腺球蛋白抗体水平（t=1.1450,P=0.2550）等方面差异均无统计学意义。术后病理结果显示,淋巴结转移阳性组患者的肿瘤突破包膜比例（26.5%比9.38%;χ~2=5.006,P=0.0253）和淋巴结复发率（14.7%比1.56%;χ~2=4.583,P=0.0323）均明显高于阴性组。淋巴结转移阳性组和阴性组的远处转移率分别为5.88%和0。结论合并Graves病甲状腺乳头状癌患者的淋巴结转移与肿瘤大小关系尚不明确,其淋巴结转移的高危因素是TR-Ab升高及肿瘤突破包膜,且淋巴结复发率更高。Objective To summarize the characteristics of lymph node metastasis in patients with papillary thyroid carcinoma accompanied with Graves disease,and to provide evidence for clinical treatment.Methods Totally 98 patients with papillary thyroid carcinoma and Graves disease who had been treated in Peking Union Medical College Hospital from January 2004 to December 2013 were divided into the lymph node metastasis positive group（ n = 34） and lymph node metastasis negative group（ n = 64）.The general information,blood biochemical results,pathological results,and prognoses were compared between these two groups.Results These two groups showed no significant differences in gender（ χ~2= 0.2113,P = 0.6458）,age（ t = 1.7000,P = 0.0922）,tumor diameter（ t = 1.2559,P = 0.2122）,and multifocal tumors（ χ~2= 1.9170,P = 0.1661）.The median level ofthyrotropin receptor antibody（ TR-Ab） value in the lymph node metastasis positive group was 4.84 U/L,which was significantly higher than that in the negative group which was 2.99 U/L（ t = 2.0169,P = 0.0465）.There were no significant differences in serum thyroid stimulating hormone（ t = 0.0257,P = 0.9800）,free triiodothyronine（ t = 1.3610,P = 0.1770）,free thyroxine（ t = 0.0082,P = 0.9930）,thyroid peroxidase antibody（ t =0.0177,P = 0.9860）,and thyroglobulin antibody levels（ t = 1.1450,P = 0.2550） between two groups.The postoperative pathological results showed that tumor capsular invasion rate（ 26.5% vs.9.38%; χ~2= 5.006,P =0.0253） and lymph node recurrence rate（ 14.7% vs.1.56%; χ~2= 4.583,P = 0.0323） were significantly higher in the positive group than in the negative group.The distal metastasis rate in the positive group and negative group were 5.88% and 0,respectively.Conclusions There is no definite association between lymph node metastasis and tumor size in patients with thyroid papillary carcinoma associated with Graves disease.The risk factors for lymph node metastasis include TR-Ab and tumor capsular invasion,with a higher

关 键 词：甲状腺乳头状癌 GRAVES病 淋巴结转移 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]