甲状腺乳头状癌跳跃性颈侧区淋巴结转移的影响因素分析  

Analysis of influencing factors for skip lateral lymph node metastasis in papillary thyroid carcinoma

作　　者：郑俊杰 游振辉[2] 张爱龙[2] 

机构地区：[1]福建医科大学省立临床医学院,福建福州350001 [2]福建省立医院基本外科,福建福州350001

出　　处：《中国普通外科杂志》2017年第11期1411-1416,共6页China Journal of General Surgery

摘　　要：目的:探讨甲状腺乳头状癌跳跃性颈侧区淋巴转移情况(颈侧区淋巴结转移而中央区淋巴结无转移)及其影响因素。方法:回顾2014年1月—2015年12月期间福建省立医院177例术后病理证实颈侧区淋巴转移的甲状腺乳头状癌患者资料(均为首次手术),分析患者临床病理特征与跳跃性颈侧区淋巴转移的关系以及跳跃性颈侧区淋巴转移的影响因素。结果:177例颈侧区淋巴转移的患者中发现29例(16.4%)跳跃性颈侧区淋巴转移。单因素分析结果显示,甲状腺乳头状癌跳跃性颈侧区淋巴转移与原发灶≤1 cm、肿瘤位置累及上极明显有关(χ~2=8.645,P=0.003;χ~2=4.267,P=0.039),与年龄、性别、病灶数、病灶分布、肿瘤侵犯、肿瘤分期、是否合并桥本病无关(均P>0.05);跳跃性颈侧区淋巴转移患者中央区及颈侧区的淋巴结检出个数及转移个数均较非跳跃性颈侧区淋巴转移患者少(均P<0.05)。Logistic回归分析结果显示,原发灶≤1 cm(OR=3.499,95%CI=1.509~8.110,P=0.004)与肿瘤累及上极(OR=0.397,95%CI=0.171~0.924,P=0.032)均为甲状腺乳头状癌跳跃性颈侧区淋巴转移独立的影响因素。结论:肿瘤直径≤1 cm、累及上极是甲状腺乳头状癌跳跃性颈侧区淋巴转移的独立影响因素。Objective： To investigate the skip lateral lymph node metastasis（lateral cervical lymph node metastasis without central lymph node metastasis） in papillary thyroid carcinoma（PTC） and the influential factors.Methods： The clinical data of 177 PTC patients with confirmed lateral cervical lymph metastasis by postoperative pathology in Fujian Province Hospital from January 2014 to December 2015 were reviewed（all patients underwent operation for the first time）. The relations of clinicopathologic features of the patients with skip lateral lymph node metastasis, and the influential factors for skip lateral lymph node metastasis were analyzed.Results： Skip metastasis was found in 29 cases（16.4%） of the 177 patients with lateral cervical lymph node metastasis. Univariate analysis showed that skip lateral lymph node metastasis in PTC was significantly related to primary tumor size≤10 mm and the primary tumor location involving the superior pole of the thyroid gland（χ~2=8.645, P=0.003; χ~2=4.267, P=0.039）, while it was irrelevant to age, gender, lesion number, lesion distribution, tumor invasion, tumor stage, and concomitant Hashimoto disease（all P0.05）; both the detected number and positive number of lgmph nodes in both central compartment and lateral neck in patients with skip lateral lymph node metastasis were significantly less than those in patients without skip lateral lymph node metastasis（all P0.05）. Logistic regression analysis revealed that the primary tumor size≤10 mm（OR=3.499, 95% CI=1.509–8.110, P=0.004） and the primary tumor location involving the superior pole of the thyroid gland（OR=0.397, 95% CI=0.171–0.924, P=0.032） were independent influencing factors for skip lateral lymph node metastasis. Conclusion： The primary tumor size≤10 mm and the primary tumor involving the superior pole of the thyroid gland are independent influencing factors for skip lateral lymph node metastasis in PTC.

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 因素分析 统计学 

分 类 号：R736.1[医药卫生—肿瘤]