甲状腺乳头状微小癌3607例淋巴结转移及生存率相关因素分析  

Factors for lymph node metastasis and survival rate in papillary thyroid microcarcinoma： from a large cohort of 3 607 cases series

作　　者：徐乐[1] 徐雅男[1] 王家东[1] 

机构地区：[1]上海交通大学医学院附属仁济医院头颈外科,200001

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第4期267-272,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：国家自然科学基金（81600790）

摘　　要：目的探讨甲状腺乳头状微小癌（papillary thyroid microcarcinoma, PTMC）颈部淋巴结转移及生存率的临床相关因素。方法回顾性分析2005年1月—2015年12月在上海交通大学附属仁济医院头颈外科接受外科手术的3 607例PTMC患者的临床资料，多因素分析统计患者颈部淋巴结转移的相关因素，Kaplan-Meier法统计患者生存率。结果3 607例PTMC患者随防18～138个月，平均68个月。患者淋巴结转移率为17.13%，其中中央区转移率为16.86%，颈侧区淋巴结转移率为1.05%。中央区淋巴结转移率与患者性别（男21.89%比女15.26%，P〈0.01）、年龄（〈45岁24.44%比≥45岁11.96%，P〈0.01）、肿瘤直径（P〈0.01）、肿瘤多灶性（多灶20.59%比单灶16.00%，P〈0.01）密切相关；颈侧区淋巴结转移率与患者年龄（〈45岁1.77%比≥45岁0.59%，P〈0.01）及肿瘤直径（P〈0.01）密切相关。3 607例患者的10年生存率为93.0%，10年无瘤生存率为87.5%，淋巴结有无转移患者10年无瘤生存率分别为75.4%和89.5%（P〉0.05）。讨论男性、年龄〈45岁、肿瘤直径更长（〉0.7 cm）、肿瘤多灶性生长的PTMC患者更易发生淋巴结转移，而患者10年生存率与这些临床特征无明显关联，其主要原因可能为高生存率的PTMC随访10年尚不足以发现影响其预后的临床因素。Objective To investigate high-risk factors for lymph node metastasis （LNM） and 10- year survival rate in patients with papillary thyroid microcarcinoma （PTMC）. Methods We retrospectively analyzed the clinical data of 3 607 patients with PTMC received surgery in our hospital from January 2005 to December 2015. Univariate and multivariate analyses were performed to identify the factors associated with metastasis and 10-year survival rate of the patients was calculated. Results The patients accepted an average follow-up of 68 months,with follow-up from 18 to 138 months. Total LNM rate in the 3 607 patients with PTMC was 17.13%. Central lymph node metastasis rate was 16. 86%, which was related to gender （males21.89% vs females 15.26%, P 〈0.01）, age （ 〈45 years old 24. 44% vs ≥ 45 years old 11.96%, P 〈 0. 01 ）, tumor diameter （ P 〈 0.01 ） and multifocality （ P 〈 0.01 ）. Lateral lymph node metastasis rate was 1.05%, which was related to age （ 〈45 vs ≥45, P 〈0. 01 ） and tumor diameter （P 〈 0. 01）. The 10-year-survival rate was 93.0% and 10-year recurrence-free survival rate was 87.5%. Conclusion PTMC may metastasize to cervical lymph node, especially in males, with age younger than 45, multifocal tumors and maximal tumor diameter larger than 0. 7 cm. There was no significant correlation between these clinical features associated with LNM and the 10-year survival rate.

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 无病生存 

分 类 号：R736.1[医药卫生—肿瘤]