甲状腺乳头状癌淋巴结转移的风险因素分析  

Analysis of risk factors for lymph node metastasis of papillary thyroid carcinoma

作　　者：段文冰[1] 张璐璐[1] 刘义刚[1] 王燕红 唐闻[1] 张瀚月 刘芸[1] DUAN Wen-bing;ZHANG Lu-lu;LIU Yi-gang;WANG Yan-hong;TANG Wen;ZHANG Han-yue;LIU Yun(Department of Clinical Laboratory,Shandong Provincial Hospital Affiliated to Shandong University,Ji’nan 250021,China)

机构地区：[1]山东大学附属省立医院医学检验部

出　　处：《临床与实验病理学杂志》2019年第7期798-803,共6页Chinese Journal of Clinical and Experimental Pathology

基　　金：山东省自然科学基金(ZR2016HM52、ZR2014HP043);山东省科学技术发展计划(2014GGH218041);山东省临床重点专科建设项目(鲁卫医字2013-26)

摘　　要：目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理学特征及淋巴结转移的风险因素。方法收集504例PTC手术标本,回顾性分析患者的临床资料及病理特点,通过单因素和多因素分析淋巴结转移的危险因素。结果(1)中央区淋巴转移中男性(47.58%)、年龄<45岁(43.49%)、合并结节性甲状腺肿(46.20%)的患者转移率均显著增高;侧颈区淋巴结转移中男性(32.26%)、肿瘤最大径>1 cm(26.08%)、多发病灶(28.64%)、合并结节性甲状腺肿(32.28%)及合并淋巴细胞性甲状腺炎(36.73%)、双侧病变(33.08%)的患者转移率均显著增高。多因素分析显示,患者性别、结节性甲状腺肿是中央区淋巴结转移的独立危险因素;患者性别、肿瘤最大径、结节性甲状腺肿及病变位置(单/双侧)是侧颈区淋巴结转移的独立危险因素。(2)单因素分析显示,多个淋巴结转移中肿瘤最大径>1 cm(14.35%)、伴钙化(24.24%)、合并结节性甲状腺肿(18.35%)及合并淋巴细胞性甲状腺炎(28.30%)、双侧病变(17.78%)的患者转移率均显著增高。多因素分析显示,肿瘤最大径、合并淋巴细胞性甲状腺炎及结节性甲状腺肿是多个淋巴结转移的独立危险因素。结论PTC患者的性别、年龄、肿瘤直径等临床病理学特征是淋巴结转移的危险因素,有望成为临床术前或术中诊断PTC依据,为制定合理的治疗方案提供帮助。Purpose To analyze the clinicopathological features of patients with papillary thyroid carcinoma(PTC)and to explore the risk factors of lymph node metastasis in patients with PTC.Methods A total of 504 surgical specimens of PTC were collected.The clinical data and pathological features of the patients were retrospectively analyzed.The risk factors of lymph node metastasis were analyzed by univariate and multivariate factors.Results(1)In patients with central lymph node metastasis,men(47.58%),age<45 years(43.49%),and nodular goiter(46.20%)had significantly higher metastatic rates.Among the patients with cervical lymph node metastasis(32.26%),the largest tumor diameter>1 cm(26.08%),multiple lesions(28.64%),and nodular goiter(32.28%)and patients with lymphocytic thyroiditis(36.73%)and bilateral lesions(33.08%)had significantly higher metastatic rates.Multivariate analysis showed that gender and nodular goiter were independent risk factors for central lymph node metastasis.Gender,tumor maximum diameter,nodular goiter and lesion location(unilateral/bilateral)were independent risk factors for lymph node metastasis in lateral cervical region.(2)Univariate analysis showed that the tumor maximum diameter was>1 cm(14.35%),calcification(24.24%),nodular goiter(18.35%),lymphocytic thyroiditis(28.30%)and bilateral lesions(17.78%)had significantly higher metastatic rates.Multivariate analysis showed that tumor maximum diameter,lymphocytic thyroiditis and nodular goiter were independent risk factors for multiple lymph node metastasis.Conclusion The clinicopathological features of PTC patients,such as gender,age,and tumor diameter are the risk factors of lymph node metastasis.It is expected to provide a basis for preoperative or intraoperative diagnosis of PTC and to provide assistance for formulating more reasonable and accurate treatment plans.

关 键 词：甲状腺肿瘤 乳头状癌 中央区淋巴结转移 侧颈区淋巴结转移 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]