cN0甲状腺乳头状癌患者颈淋巴结转移的高危因素分析  

Analysis on risk factors of cervical lymph node metastasis in cN0 papillary thyroid carcinom

作　　者：庞玉娟[1] 陈晓红[2] 张景义[1] 高景利[1] 

机构地区：[1]华北理工大学附属医院开滦总医院内分泌科,河北唐山063000 [2]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科、耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),北京100730

出　　处：《中国耳鼻咽喉头颈外科》2017年第7期329-332,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的探讨cN0甲状腺乳头状癌颈淋巴结转移的高危因素。方法回顾性分析北京同仁医院20 09~2015年537例cN0甲状腺乳头状癌的临床资料,统计患者性别、年龄、多发灶、合并桥本甲状腺炎、突破包膜和肿瘤直径。结果 537例cN0甲状腺乳头状癌患者颈淋巴结转移率30.9%(166/537),其中单纯VI区转移率24.95%(134/537),VI区+颈侧转移率5.21%(28/537),单纯颈侧率0.74%(4/537)。卡方检验和多因素logistic回归分析显示颈淋巴结转移与男性、年龄<45岁、突破包膜与肿瘤直径>1 cm有关(P<0.05)。术后17例患者暂时声嘶,1例失访,1例随访1.5年未完全恢复正常。术后61例患者暂时低钙,2例失访,2例分别随访1.5和4年,仍需补钙。结论对cN0甲状腺乳头状癌患者进行危险度分层,男性、年龄<45岁、突破包膜、肿瘤直径>1 cm是颈淋巴结转移的高危因素,建议个体化治疗,行预防性中央区淋巴结清扫。OBJECTIVE To explore risk factors of cervical lymph node metastasis in cN0 papillary thyroid carcinoma. METHODS The clinical data of 537 patients with cN0 papillary thyroid carcinoma were analyzed retrospectively in Beijing Tongren hospital from Jan 2009 to Dec 2015. Patients＇ gender, age, multifocal lesion, carcinoma complicated with Hashimoto＇s thyroiditis, capsule breakthrough and tumor size were counted. RESULTS The lymph node metastasis rate of 537 patients with cN0 papillary thyroid carcinoma was 30.9%（166/537）. The incidences of lymph node involvement were 24.95%（166/537） at only level VI, 5.21%（28/537） at level VI plus lateral part of neck and 0.74%（4/537） at only skip metastasis, respectively. Chi square test and multivariate logistic regression analysis showed that cervical lymph node metastasis was statistically associated with male, age〈45 years, capsule breakthrough and tumor diameter〉l cm （P〈0.05）. After the operation, there were 17 patients with temporary hoarseness, accompanied with 1 loss to follow-up and 1 failure to return to normal after 1.5 years. There were 61 patients with temporary hypocalcemia, 2 patients failed to follow-up and 2 patients with calcium supplements after respective 1.5 and 4 years. CONCLUSION To stratify the risk of patients with cN0 papillary thyroid carcinoma, male, age〈45 years, capsule breakthrough and tumor diameter〉1cm are risk factors for cervical lymph node metastasis. And we suggest that prophylactic central lymph node dissection may be appropriate.

关 键 词：甲状腺肿瘤 肿瘤 乳头状 危险因素 淋巴结 转移 颈 

分 类 号：R736.1[医药卫生—肿瘤]