cN0甲状腺乳头状癌中央区淋巴结微转移的初步研究  

Preliminary study of lymph node micrometastasis in the central compart-ment of cN0 papillary thyroid carcinoma

作　　者：韩春[1] 王可敬[1] 张谷[2] 徐加杰[1] 郑伟慧[1] 

机构地区：[1]浙江省肿瘤医院头颈外科,浙江杭州310022 [2]浙江省肿瘤医院病理科,浙江杭州310022

出　　处：《中国现代医生》2017年第2期1-4,F0003,共5页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2012KYB033);浙江省科技厅公益技术研究社会发展项目(2015C33211)

摘　　要：目的探讨cN0甲状腺乳头状癌中央区淋巴结的微转移情况,探讨逆转录聚合酶链反应(RT-q PCR)技术对诊断淋巴结微转移灶的价值,并筛选微转移的临床病理高危因素。方法选取2012年11月~2014年3月浙江省肿瘤医院收治的cN0甲状腺乳头状癌患者48例,对从中取到136个病理证实无转移的中央区淋巴结分别用免疫组化和RT-q PCR检测CK19的表达情况。将患者的各项临床病理相关因素作为自变量,以淋巴结微转移因素作为因变量,应用二分类变量Logistic回归模型进行多因素分析,以期发现微转移可能的高危因素。结果免疫组化检测CK19为15.44%(21/136),RT-q PCR法的阳性检出率为82.35%(112/136)。RT-q PCR法与免疫组化法比较具有显著差异。Logistic回归模型中筛选出肿瘤甲状腺包膜侵犯是c N0甲状腺乳头状癌中央区淋巴结微转移的危险因素。结论应用RT-q PCR检测CK19表达,可提高对甲状腺癌的淋巴结微转移阳性检出率。肿瘤甲状腺包膜侵犯是淋巴结微转移的独立危险因素。Objective To investigate the micrometastasis of lymph node in the central compartment of cNO papillary thy- roid carcinoma, to explore the value of reverse transcription polymerase chain reaction（RT-qPCR） in the diagnosis of lymph node micrometastasis, and to screen the clinical pathological risk factors of micrometastasis. Methods A total of 48 patients with cNO thyroid papillary carcinoma who were admitted to Zhejiang Cancer Hospital from November 2012 to March 2014 were enrolled in this study. The expression of CK19 was detected by immunohistochemistry and RT= qPCR in 136 lymph nodes in the central zone collected from them, which was pathologically confirmed without metas- tasis. The clinicopathological factors of patients were taken as independent variables, and lymph node micrometastasis factors were taken as the dependent variables. Multivariate analysis was applied by binary variables Logistic regression model, so as to explore the possible risk factors of micrometastasis. Results CK19 was detected by immunohistochem- istry in 15.44%（21/136）. The positive rate of CK19 was 82.35%（112/136） by RT-qPCR. RT-qPCR method and im- munohistochemical method were compared, and the differences were significant. Logistic regression analysis showed that tumor thyroid capsule invasion was the risk factor of central zone lymph node micrometastasis in cNO papillary thyroid carcinoma. Conclusion The test of CK19 expression by RT-qPCR can increase the positive detection rate of lymph node micrometastasis in thyroid carcinoma. Tumor thyroid capsule invasion is an independent risk factor for lymph node micrometastasis.

关 键 词：甲状腺肿瘤 甲状腺乳头状癌 细胞角蛋白19 微转移 聚合酶链反应 

分 类 号：R736.1[医药卫生—肿瘤]