甲状腺微小乳头状癌与直径≥2cm甲状腺乳头状癌的临床病理特点研究  

Clinicopathological characteristics between papillary thyroid microcarcinoma and papillary thyroid carcinoma of diameter≥2 cm

作　　者：王旖君 倪美琪 史晓光[1] 滕卫平[1] Wang Yijun;Ni Meiqi;Shi Xiaoguang;Teng Weiping(Liaoning Provincial Key Laboratory of Endocrine Disease,Institute of Endocrinology,Department of Endocrinology and Metabolism,the First Affiliated Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院内分泌与代谢病科,内分泌研究所,辽宁省内分泌疾病重点实验室,辽宁110001

出　　处：《中华内分泌代谢杂志》2021年第6期548-553,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金项目(81870543);辽宁省科技厅资助项目(20180530060)。

摘　　要：目的比较甲状腺微小乳头状癌(PTMC)与直径≥2 cm甲状腺乳头状癌(PTC)之间临床病理特点的差异。方法回顾性分析2010年1月至2017年5月在中国医科大学附属第一医院接受手术治疗且经病理证实的直径≤9 cm PTC患者(n=1404)的临床、病理及随访资料,根据肿瘤直径将患者分为PTMC组和直径≥2 cm PTC组,直径≥2 cm PTC再以4 cm为界分为2个亚组,比较各组临床病理特点,并分析影响肿瘤伴颈部淋巴结转移、术后复发的危险因素。结果(1)共纳入符合条件的患者1404例,其中PTMC组1001例(71.3%),直径≥2 cm PTC组403例(28.7%),中位随访时间为43.00(8.00~94.00)个月,2组在性别、年龄、血清促甲状腺激素(TSH)水平、双叶、多灶性、伴颈部淋巴结转移、腺体外浸润、体重指数、术后死亡、术后复发及131I治疗率方面差异有统计学意义;PTMC组、2 cm≤直径≤4 cm PTC组、4 cm<直径≤9 cm PTC组在年龄、血清TSH水平、双叶、多灶性、伴颈部淋巴结转移、腺体外浸润、术后复发及131I治疗率方面差异有统计学意义。(2)单因素分析显示,影响PTMC伴颈部淋巴结转移的因素包括男性、年龄减小、肿瘤直径增大、双叶、多灶性和腺体外浸润;影响2 cm≤直径≤4 cm PTC伴颈部淋巴结转移的因素包括年龄减小和腺体外浸润;影响PTMC术后复发的因素包括腺体外浸润和伴颈部淋巴结转移;影响2 cm≤直径≤4 cm PTC术后复发的因素包括年龄增加和肿瘤直径增大。(3)多因素分析显示,年龄<45岁、肿瘤直径增大是PTMC伴颈部淋巴结转移的独立危险因素;年龄<45岁是2 cm≤直径≤4 cm PTC伴颈部淋巴结转移的独立危险因素;肿瘤直径增大是2 cm≤直径≤4 cm PTC术后复发的独立危险因素。结论PTMC和直径≥2 cm PTC临床病理特点差异明显,年龄<45岁、肿瘤直径增大是影响预后的独立危险因素。Objective To compare the differences in clinicopathological characteristics between papillary thyroid microcarcinoma(PTMC)and papillary thyroid carcinoma(PTC)with a diameter≥2 cm.Methods Clinicopathological and follow-up information of 1404 PTC cases with diameter≤9 cm who received surgery and were confirmed pathologically from January 2010 to May 2017 in the First Hospital of China Medical University were analyzed retrospectively.All cases were divided into PTMC group and diameter≥2 cm PTC group according to tumor diameter.The diameter of≥2 cm PTC group was further categorized into two subgroups with 4 cm as the boundary.Clinical and pathological characteristics were analyzed.Meanwhile,risk factors that affected lymph node metastasis and postoperative recurrence of tumor were analyzed as well.Results(1)A total of 1404 eligible patients were included,consisting of 1001 cases(71.3%)of PTMC and 403 cases(28.7%)of PTC of diameter≥2 cm with a median follow-up time of 43.00(8.00-94.00)months.There were statistical differences in gender,age,serum thyroid stimulating hormone(TSH)level,bilobe,multifocality,cervical lymph node metastasis,extrathyroidal extension,body mass index,postoperative death,postoperative recurrence,and 131I treatment rate between two groups.Age,serum TSH level,bilobe,multifocality,cervical lymph node metastasis,extrathyroidal extension,postoperative recurrence,and 131I treatment rate were found statistically different among the PTMC group,2 cm≤diameter≤4 cm PTC group,and 4 cm<diameter≤9 cm PTC group.(2)The univariate analysis showed that the influencing factors of PTMC with cervical lymph node metastasis included male,younger age,larger tumor diameter,bilobe,multifocality,and extrathyroidal extension.The factors influencing 2 cm≤diameter≤4 cm PTC with cervical lymph node metastasis were younger age and extrathyroidal extension.Extrathyroidal extension and cervical lymph node metastasis were associated with recurrence of PTMC,while older age and larger tumor diameter were related

关 键 词：甲状腺微小乳头状癌 甲状腺乳头状癌 临床病理特点 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]