cN0期甲状腺乳头状微小癌中央区淋巴结转移危险因素的Meta分析  

Risk factors for central lymph node metastasis of cN0 papillary thyroid microcarcinoma:A meta-analysis

作　　者：武元元[1] 刘锐锋[2] 范向达[1] 王军[1] Wu Yuanyuan;Liu Ruifeng;Fan Xiangda;Wang Jun(Department of Head and Neck,Gansu Province Cancer hospital,Gansu,Lanzhou,730500,China;Department of Radiotherapy,Gansu Province Cancer hospital,Gansu,Lanzhou,730500,China)

机构地区：[1]甘肃省肿瘤医院头颈外科,甘肃兰州730050 [2]甘肃省肿瘤医院放疗科,甘肃兰州730050

出　　处：《中国医学文摘（耳鼻咽喉科学）》2020年第1期4-9,F0002,共7页Chinese Medical Digest(Otorhinolaryngology)

基　　金：甘肃省卫生行业科研计划项目(项目编号:GSWSKY2018-05);陇原青年创新创业人才项目[项目编号:甘组通字(2019)39号]。

摘　　要：目的探讨cN0期甲状腺乳头状微小癌(PTMC)中央区淋巴结转移(CLNM)的危险因素,为高危PTMC患者行预防性中央区淋巴清扫术(PCND)提供依据。方法检索2018年10月以前PubMed、EMBASE、Cochrane Library数据库以及万方、VIP、CNKI数据库中收录的关于PTMC颈部CLNM危险因素的文献,按纳入和排除标准筛选文献,评价文献质量后采用Stata12.0软件进行Meta分析,利用固定/随机效应模型计算各变量比值比(OR)及其95%可信区间(95%CI),采用Egger检验评估文献的发表偏倚。结果最终纳入文献26篇,共11619例患者,发生CLNM者3955例(34.04%)。Meta分析结果显示,男性(OR=1.85,95%CI=1.68-2.05,P=0.000)、年龄<45岁(OR=1.52,95%CI=1.33-1.72,P=0.000)、肿瘤直径>5 mm(OR=1.99,95%CI=1.81-2.19,P=0.000)、双侧(OR=1.49,95%CI=1.14-1.94,P=0.003)、多灶(OR=1.84,95%CI=1.61-2.09,P=0.000)、腺外侵犯(OR=2.43,95%CI=2.01-2.93,P=0.000)及BRAFV600E突变(OR=1.84,95%CI=1.26-2.68,P=0.002)是cN0期PTMC患者CLNM的危险因素;桥本氏甲状腺炎(OR=0.94,95%CI=0.77-1.15,P=0.53)与cN0期PTMC患者CLNM无明显相关。结论男性、年龄<45岁、肿瘤直径>5 mm、双侧、多灶性、腺外侵犯及BRAFV600E突变是CLNM的危险因素,具有相关危险因素的cN0期PTMC患者应积极行PCND。Objective To investigate the risk factors of central lymph node metastasis(CLNM)of cN0 papillary thyroid microcarcinoma(PTMC),and provide basis for prophylactic central lymph node dissection(PCND)in high-risk PTMC patients.Methods Published articles about clinicopathological factors of CLNM in PTMC were searched in database of PubMed,EMBASE,Cochrane library,Wanfang,VIP and CNKI until October 2018 to identify relevant studies according to the predefined inclusion and exclusion criteria.Statistical analysis was performed using Stata 12.0 software.The outcomes were clinical and pathologic factors for CLNM,then individual and pooled odds ratios(OR)with 95%confidence interval(CI)of each outcome were analyzed by fixed/random-effects models.Egger test were applied to assess the publication bias of the literatures.Results Twenty-six eligible studies enrolling 11619 patients were identified,and 3955 patients accounting for 34.04%of the total patients had CLNM.Meta-analysis revealed that an increased risk of CLNM was associated with male gender(OR=1.85,95%CI=1.68-2.05,P=0.000),age<45 years(OR=1.52,95%CI=1.33-1.72,P=0.000),tumor diameter>5 mm(OR=1.99,95%CI=1.81-2.19,P=0.000),bilateral tumors(OR=1.49,95%CI=1.14-1.94,P=0.003),multifocality(OR=1.84,95%CI=1.61-2.09,P=0.000),extrathyroidal extension(OR=2.43,95%CI=2.01-2.93,P=0.000)and BRAFV600E mutation(OR=1.84,95%CI=1.26-2.68,P=0.002),while Hashimoto’s thyroiditis(OR=0.94,95%CI=0.77-1.15,P=0.53)had no association with CLNM in cN0 PTMC patients.Conclusions Male gender,age<45 years,tumor diameter>5mm,bilateral tumors,multifocality,extrathyroidal extension and BRAFV600E mutation were risk factors for CLNM,therefore,PCND should be performed in cN0 PTMC patients with these risk factors.

关 键 词：甲状腺乳头状微小癌 中央区淋巴结转移 危险因素 META分析 

分 类 号：R73[医药卫生—肿瘤]