cN0期甲状腺微小乳头状癌侧颈淋巴结转移危险因素分析  

Analysis of risk factors for lateral neck lymph node metastasis in cN0 papillary thyroid microcarcinoma

作　　者：沈文亮 吕晶[1] 黑虎 秦建武 SHEN Wenliang;LU Jing;HEI Hu;QIN Jianwu(Department of Thyroid Surgery, Zhengzhou Central Hospital Affiliated of Zhengzhou University, Zhengzhou 450007, China;Department of Thyroid and Neck Surgery, Henan Cancer Hospital Affiliated of Zhengzhou University, Zhengzhou 450008, China)

机构地区：[1]郑州大学附属郑州市中心医院甲状腺外科,河南郑州450007 [2]郑州大学附属肿瘤医院甲状腺头颈外科,河南郑州450008

出　　处：《中国普通外科杂志》2019年第5期551-557,共7页China Journal of General Surgery

摘　　要：目的:探讨甲状腺微小乳头状癌(PTMC)患者侧颈区淋巴结转移的危险因素。方法:回顾性分析462例临床淋巴结阴性(cN0)的PTMC患者的术前彩超及临床病理资料,应用χ~2检验和多因素Logistic回归分析侧颈区淋巴结转移危险因素。结果:全组患者中PTMC中央区淋巴结转移率为38.5%,侧颈区淋巴结转移率为23.6%。单因素分析显示,性别(χ~2=7.312,P<0.05)、肿瘤直径(χ~2=14.321,P<0.001)、包膜受侵(χ~2=21.689,P<0.001)、多灶癌(χ~2=13.086,P<0.001)、中央区淋巴结阳性(χ~2=69.421,P<0.001)、肿瘤位置(χ~2=19.028,P<0.001)与侧颈区淋巴结转移明显有关;多因素Logistic回归分析显示,男性(OR=1.758)、肿瘤直径≥7mm(OR=1.710)、包膜受侵(OR=3.337)、多灶(OR=1.778)、中央区淋巴结阳性(OR=7.504)、肿瘤位于上极(OR=4.084)是PTMC患者侧颈区淋巴结转移的独立危险因素(均P<0.05)。侧颈区淋巴结的转移风险随中央区淋巴结转移数目的增多而增加(≥3枚:OR=19.957)。结论:cN0期PTMC的侧颈淋巴结转移与多个因素有关,对于存在这些危险因素的患者,首次手术治疗时应考虑行患侧侧颈区淋巴结探查。Objective: To investigate the risk factors of lateral neck lymph node metastasis in patients with papillary thyroid microcarcinoma (PTMC). Methods: The preoperative color Doppler results and clinicopathologic data of 462 patients with clinical lymph node negative (cN0) PTMC were retrospectively analyzed. The risk factors for lateral neck lymph node metastasis were determined by χ^2 test and Logistic regression analysis. Results: In the entire group of patients, the rate of central neck lymph node metastasis was 38.5% and the rate of lateral neck lymph node metastasis was 23.6%. The results of univariate analysis showed that sex (χ^2=7.312, P<0.05), tumor diameter (χ^2=14.321, P<0.001), thyroid capsule invasion (χ^2=21.689, P<0.001), multiple tumors (χ^2=13.086, P<0.001), tumor location (χ^2=19.028, P<0.001) and central neck lymph node metastasis (χ^2=69.421, P<0.001) were significantly associated with lateral lymph node metastasis. The results of multivariate Logistic regression analysis indicated that male sex (OR=1.758), tumor diameter ≥7 mm (OR=1.710), thyroid capsule invasion (OR=3.337), multiple tumors (OR=1.778), central neck lymph node metastasis (OR=7.504) and tumor in the superior pole (OR=4.084) were independent risk factors for lateral neck lymph node metastasis (all P<0.05). The risk of lateral neck lymph node metastasis was increased with the increase of the number of affected central neck lymph nodes (≥3: OR=19.957). Conclusion: In patients with cN0 PTMC, lateral lymph node metastasis is related to a number of factors. For those who have one or more of them, lateral neck lymph node exploration of the affected side is recommended in the first surgery.

关 键 词：甲状腺肿瘤 乳头状癌 淋巴转移 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]