PTMC临床病理特征与CLNM相关性分析  

Correlation Analysis of Clinicopathological Characteristics of PTMC with CLNM

作　　者：宋创业[1] 孟艳林[2] 刘攀云 严丽[4] SONG Chuang-ye;MENG Yan-lin;LIU pan-yun;YAN Li(Department of General Surgery,the 81 th Group Military Hospital of the Chinese People’s Liberation Army,Zhangjiakou,Hebei 075000,China;Department of Disease Prevention and Control,the 81 th Group Military Hospital of the Chinese People’s Liberation Army,Zhangjiakou,Hebei 075000,China;Department of Endocrinology,the 81 th Group Military Hospital of the Chinese People’s Liberation Army,Zhangjiakou,Hebei 075000,China;Department of Gland Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang,Hebei 050005,China)

机构地区：[1]中国人民解放军陆军第八十一集团军医院普通外科,河北张家口075000 [2]中国人民解放军陆军第八十一集团军医院疾病预防控制科,河北张家口075000 [3]中国人民解放军陆军第八十一集团军医院内分泌科,河北张家口075000 [4]河北医科大学第二医院腺体外科,河北石家庄050005

出　　处：《河北北方学院学报（自然科学版）》2021年第12期6-10,共5页Journal of Hebei North University:Natural Science Edition

基　　金：张家口市重点研发计划项目(No.1921125H)。

摘　　要：目的对甲状腺微小乳头状癌(PTMC)患者的临床病理特征与中央区淋巴结转移(CLNM)相关性进行分析,旨在为临床实施精准化、科学化治疗提供参考依据。方法回顾性分析经手术治疗的440例PTMC患者病历资料,应用χ^(2)检验及Logistic多因素回归模型对入选患者性别、年龄、肿瘤大小、多灶性、双侧癌、包膜侵犯及BRAF^(V600E)突变、中性粒细胞/淋巴细胞计数比值(NLR)、血小板/淋巴细胞计数比值(PLR)水平与CLNM相关性进行单因素及多因素分析。结果单因素相关性分析结果显示,患者性别、年龄与CLNM发生无明显相关性(P>0.05);肿瘤直径≥5 mm、肿瘤多灶性、双侧癌、包膜侵犯、NLR≥2.5、PLR≥175及BRAF^(V600E)突变与CLNM发生风险明显相关(P<0.05),是CLNM的独立危险因素。Logistic多因素分析结果显示肿瘤大小、肿瘤多灶性、包膜侵犯、BRAF^(V600E)突变、NLR以及PLR是CLNM的独立危险因素(P<0.05)。性别、年龄、双侧癌与CLNM无明显相关(P>0.05)。肿瘤直径≥5mm、肿瘤多灶性、包膜侵犯、BRAF^(V600E)突变、NLR≥2.5及PLR≥175的患者发生CLNM的风险更高。其中,BRAF^(V600E)突变及NLR≥2.5是影响CLNM最重要的两个独立危险因素。结论肿瘤直径≥5 mm、肿瘤多灶性、包膜侵犯及BRAF^(V600E)突变、NLR≥2.5、PLR≥175均为PTMC发生CLNM的独立危险因素;对于存在包膜侵犯、BRAF^(V600E)突变及NLR值≥2.5的患者应着重考虑行预防性中央区淋巴结清扫(pCLND)。Objective To conduct the correlation analysis of clinicopathological characteristics of papillary thyroid microcarcinoma(PTMC)with central lymph node metastasis(CLNM),and to provide a reference evidence for the accurate and scientific treatment.Methods The medical records of PTMC patients who had undergone the thyroid surgery were retrospectively analyzed.Chi-square test and Logistic multi-factor regression model were used for single-factor and multi-factor correlation analysis of gender,age,tumor size,multifocality,bilateral cancer,capsular invasion,BRAF^(V600E)mutation,neutrophil-to-lymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR)levels with CLNM.Results Single-factor correlation analysis results showed that gender and age had no significant correlation with CLNM(P>0.05);while tumor diameter(≥5 mm),multifocality,bilateral cancer,capsular invasion,NLR≥2.5,PLR≥175,and BRAF^(V600E)mutation had significant correlation with CLNM(P<0.05),which were the independent risk factors for CLNM.Logistic multi-factor analysis showed that tumor size,multifocality,capsular invasion,BRAF^(V600E)mutation,NLR,and PLR were the independent risk factors for CLNM(P<0.05).Gender,age,and bilateral cancer had no significant correlation with CLNM(P>0.05).Patient with tumor size≥5 mm,multifocality,capsular invasion,BRAF^(V600E)mutation,NLR≥2.5,and PLR≥175 had more risk for CLNM,among which BRAF^(V600E)mutation and NLR≥2.5 were the two most important independent risk factors for CLNM.Conclusion Tumor diameter≥5 mm,multifocality,capsular invasion,BRAF^(V600E)mutation,NLR≥2.5,and PLR≥175 are the independent risk factors for CLNM in patients with PTMC;therefore,patients with capsular invasion,BRAF^(V600E)mutation,NLR≥2.5 should were given prophylactic central lymph node dissection(pCLND)with special consideration.

关 键 词：PTMC CLNM BRAF^(V600E)突变 NLR PLR 

分 类 号：R736.1[医药卫生—肿瘤]