乳头状甲状腺微小癌跳跃性侧颈淋巴结转移的临床风险因素分析及模型预测  

Clinical risk factors analysis and model prediction of skip lateral cervical lymph node metastasis in papillary thyroid microcarcinoma

作　　者：时晶晶 丁金旺 彭友 张煜 潘钢[1] 周力 叶柳青 Shi Jingjing;Ding Jinwang;Peng You;Zhang Yu;Pan Gang;Zhou Li;Ye Liuqing(Department of Oncological Surgery,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Department of Head and Neck Surgery,Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Key Laboratory of Head&Neck Cancer Translational Research of Zhejiang Province,Hangzhou 310022,China;Department of Clinical Laboratory,Cancer Hospital of the University of Chinese Academy of Sciences(Zhejiang Cancer Hospital),Hangzhou 310022,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院肿瘤外科,310006 [2]中国科学院大学附属肿瘤医院(浙江省肿瘤医院)头颈外科浙江省头颈肿瘤转化医学研究重点实验室,杭州310022 [3]中国科学院大学附属肿瘤医院(浙江省肿瘤医院)检验科,杭州310022

出　　处：《中华实验外科杂志》2020年第12期2289-2291,共3页Chinese Journal of Experimental Surgery

基　　金：浙江省公益技术应用研究项目(2017C33180);浙江省医药卫生科技计划项目(2018KY576);杭州市科技计划项目(20180533B37);杭州市卫生科技计划项目(0020190151)。

摘　　要：目的探讨乳头状甲状腺微小癌(PTMC)跳跃性侧颈淋巴结转移的临床风险因素,并建立临床预测模型。方法回顾性分析2010年1月至2019年9月在浙江大学医学院附属杭州市第一人民医院集团住院并接受侧颈改良式淋巴结清扫的541例甲状腺乳头状癌(PTC)的临床病理资料,根据是否出现跳跃性侧颈淋巴结转移分为跳跃性转移组及非跳跃性转移组,采用统计分析的方法研究PTMC出现跳跃性侧颈淋巴结转移的临床危险因素,并建立数学模型、评价其预测价值。计量资料组间比较采用Wilcoxon检验;计数资料组间差异采用χ^2检验。结果541例PTC中PTMC占30.68%(166例),166例PTMC中共计174侧颈侧区淋巴结纳入研究,出现跳跃性侧颈淋巴结转移的概率为24.71%(43/174)。统计分析显示PTMC患者的初诊年龄>40岁、单侧病灶以及患侧中央区淋巴结清扫数<6枚与跳跃性侧颈淋巴结转移相关(Wals值分别为5.150、3.940、6.726,P值均<0.05),构建的数学模型(Y=-2.915+0.896×初诊年龄+0.854×单双侧+1.040×患侧中央区淋巴结清扫数)对预测PTMC出现跳跃性侧颈淋巴结转移的敏感性为86.05%,特异性为46.56%(Z值=4.970,P<0.05)。结论以年龄>40岁、单侧病灶、患侧中央区淋巴结清扫数目<6枚构建的数学模型对预测PTMC出现跳跃性侧颈淋巴结转移具有一定价值。Objective To investigate the clinical risk factors of skip lateral cervical lymph node metastasis of papillary thyroid microcarcinoma(PTMC)and establish the clinical prediction model.Methods A retrospective analysis was performed on the clinicopathological data of 541 patients with papillary thyroid carcinoma(PTC)who were admitted to hangzhou first people’s hospital(group)affiliated to zhejiang university school of medicine and underwent modified lateral neck lymph node dissection.According to the presence or absence of skip lateral cervical lymph node metastasis,the patients were divided into skipping group and non-skipping group.Analysis were applied to study the relationship between skip lateral cervical lymph node metastasis of PTMC and clinical pathological characteristics.A mathematical model was also established to evaluate its predictive value.Results PTMC accounted for 30.68%(166 cases)in 541 cases of PTC.A total of 174 cervical lymph nodes in 166 cases of PTMC were included in the study,and the probability of skip lateral cervical lymph node metastasis was 24.71%(43/174).Analysis showed that the skip lateral cervical lymph node metastasis of PTMC was related to the initial diagnosis age(>40 years),unilateral lesion and the number of lymph nodes(<6)dissected in the central region of the affected side(Wals were 5.150,3.940 and 6.726,respectively,P<0.05).The mathematical model(Y=-2.915+0.896×initial diagnosis age+0.854×unilateral bilateral+1.040×number of lymph nodes dissected in the central region of the affected side)of skip lateral cervical lymph node metastasis in PTMC.The sensitivity and specificity were 86.05%and 46.56%respectively(Z=4.970,P<0.05).Conclusion The age>40 years,unilateral lesion and the number of lymph nodes(<6)dissected in the central region of the affected side were independent predictors of skip lateral cervical lymph node metastasis in PTMC,and the mathematical model has high predictive value.

关 键 词：乳头状甲状腺微小癌 跳跃性侧颈淋巴结转移 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]