单发甲状腺乳头状癌侧颈部淋巴结转移的相关因素分析  

Risk factors of predicting lateral neck lymph node metastasis following solitary papillary thyroid carcinoma

作　　者：周瑾 周世崇 李佳伟 王宇 陈雅玲 王芬 智文祥 陈敏 常才 Zhou Jin;Zhou Shichong;Li Jiawei;Wang Yu;Chen Yaling;Wang Fen;Zhi Wenxiang;Chen Min;Chang Cai(Department of Medical Ultrasound,Fudan University Shanghai Cancer Center,Department of Oncology,Shanghai Medical College,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属肿瘤医院超声诊断科,复旦大学上海医学院肿瘤学系,200032

出　　处：《中华超声影像学杂志》2019年第11期971-975,共5页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金(81401422);上海市科学技术委员会引导项目(17411953400,17411963300);上海申康医院发展中心项目(SHDC22015016)。

摘　　要：目的研究单发甲状腺乳头状癌(papillary thyroid carcinoma,PTC)临床及超声特征与侧颈部淋巴结转移(lateral lymph node metastasis,LLNM)的危险因素并建立列线图模型。方法回顾性分析复旦大学附属肿瘤医院2016年1-9月术后病理为单发PTC的患者,评估患者临床特征,包括性别、年龄、促甲状腺激素(TSH)、甲状腺球蛋白(Tg)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)水平、中央区淋巴结转移(central lymph node metastasis,CLNM),及原发PTC病灶超声特征,包括病灶最大径、位置、纵横比、是否紧贴甲状腺包膜、回声、边缘、声晕、微钙化等,将其分为LLNM阳性组及阴性组,行单因素及多因素分析并建立列线图模型,最后用ROC曲线评价其应用价值。结果1174例患者中,125例(10.6%)LLNM阳性,其中10例为跳跃性转移。单因素分析显示:性别、术前Tg、TGAb、CLNM、病灶最大径、位置、紧贴甲状腺被膜、回声、纵横比、声晕、微钙化为LLNM的相关因素(P<0.05);二项逻辑回归分析显示:CLNM、病灶最大径(>10 mm)、微钙化、位置(上部、多部位)为LLNM独立危险因素。列线图模型AUC 0.865,敏感性88.0%,特异性75.2%,准确性76.6%。结论单发PTC患者存在CLNM、病灶较大、位于甲状腺上部且存在微钙化为LLNM的独立危险因素,该列线图模型可尝试临床应用。Objective To evaluate the risk factors in terms of clinical characteristics and sonographic features regarding solitairy thyroid papillary carcinoma(PTC)for the lateral cervical lymph node metastasis(LLNM)and then to establish nomogram model.Methods All patients were confirmed to be solitary PTC in paraffin wax pathology after thyroidectomy in Fudan University Shanghai Cancer Center from January to September 2016.Meanwhile,the status of lateral cervical lymph node metastasis was determined referring to postoperative pathology.Clinical characteristics including gender,age,preoperative thyroid stimulating hormone(TSH),thyroglobulin(Tg),thyroglobulin antibody(TGAb),thyroid peroxidase antibody(TPOAb),central lymph node metastasis(CLNM)and sonographic features of the PTC lesion including maximum tumor diameter,location,aspect ratio,relation with thyroid capsule,echo,margin,acoustic halo,microcalcification were evaluated for the association with lateral cervical lymph node metastasis using univariate and multivariate logistic regression analyses.Then the nomogram model was established and its application value was evaluated using ROC.Results Out of 1174 patients,125 patients(10.6%)presented lateral neck lymph node metastasis and 10 patients presented skipping metastasis.Univariate analysis showed gender,preoperative Tg and TGAb,CLNM,maximum tumor diameter,location,close to the thyroid tumor capsule,echo,aspect ratio,acoustic halo,microcalcification were associated with LLNM(P<0.05).Binomial logistic regression analysis indicated CLNM,maximum tumor diameter of larger than 10 mm,superior or multiple location,microcalcification were independent risk factors of LLNM.The AUC of the nomogram model was 0.865,the sensitivity was 88.0%,the specificity was 75.2%,and the accuracy was 76.6%.Conclusions As for patients with single focal PTC,CLNM,larger lesions,microcalcification,superior location are associated with lateral neck lymph node metastasis.The nomogram model can be tried for clinical application.

关 键 词：超声检查 甲状腺乳头状癌 侧颈部淋巴结转移 危险因素 列线图 

分 类 号：R73[医药卫生—肿瘤]