甲状腺髓样癌颈侧区淋巴结转移的危险因素分析  

Risk factors analysis of lateral cervical lymph node metastasis in medullary thyroid carcinoma

作　　者：张传灼 任明 孟达理 王平[2] 王勇[2] ZHANG Chuanzhuo;REN Ming;MENG Dali(Department of General Surgery,Affiliated Hospital of Nanjing University of Chinese Medicine,Nanjing 210000,China;不详)

机构地区：[1]南京中医药大学附属医院普外科,210000 [2]浙江大学医学附属第二医院甲状腺外科

出　　处：《临床外科杂志》2022年第3期230-233,共4页Journal of Clinical Surgery

摘　　要：目的 探讨甲状腺髓样癌(medullary thyroid carcinoma, MTC)颈侧区淋巴结转移的危险因素,研究血清降钙素(calcitonin, Ctn)预测颈侧区淋巴结转移的价值。方法 回顾分析47例经术后病理诊断为MTC的临床病理资料,按颈侧区有无淋巴结转移分为两组,单因素和Logistic回归分析颈侧区淋巴结转移的危险因素,通过ROC曲线研究Ctn值预测颈侧区淋巴结转移的敏感性和特异性。结果 单因素分析显示,颈侧区转移组MTC直径更大(P=0.004),血清Ctn(P=0.000)和癌胚抗原(P=0.003)更高,肿瘤多发比率(55.56%vs 13.79%,P=0.004)及中央区淋巴结转移率更高(77.78%vs 37.93%,P=0.015)。回归分析发现,血清Ctn(P=0.036)升高及中央区淋巴结转移(P=0.017)是颈侧区转移的独立危险因素。当Ctn截点为300.9 ng/L时,其预测颈侧区淋巴结转移的敏感性是94.4%,特异性是62.1%,ROC曲线下面积(AUC)是0.808。结论 血清Ctn升高及中央区淋巴结转移是MTC颈侧区淋巴结转移的独立危险因素,Ctn可作为预测颈侧区淋巴结转移的一种敏感性指标。Objective To investigate the risk factors of cervical lymph node metastasis of medullary thyroid carcinoma(MTC),and to investigate the value of serum calcitonin(Ctn) in predicting cervical lymph node metastasis.Methods The clinicopathological data of 47 patients with postoperative pathological diagnosis of MTC were retrospectively analyzed, and divided into two groups according to whether or not there were cervical lymph node metastasis.The risk factors of cervical lymph node metastasis were analyzed by univariate analysis and Logistic regression analysis.The sensitivity and specificity of Ctn value in predicting cervical lymph node metastasis were studied by ROC curve.Result Univariate analysis showed that the lateral cervical metastasis group had larger MTC diameter(P=0.004),higher serum Ctn(P=0.000) and CEA(P=0.003),multiple lesions rate(55.56% vs 13.79%,P=0.004) and higher central lymph node metastasis rate(77.78% vs 37.93%,P=0.015).Regression analysis showed that increased serum Ctn(P=0.036) and central lymph node metastasis(P=0.017) were independent risk factors for lateral cervical metastasis.When the Ctn cut-off point was 300.9 ng/L,the sensitivity, specificity and area under ROC curve(AUC) for predicting lateral cervical lymph node metastasis were 94.4%,62.1% and 0.808 respectively.Conclusion Elevated serum Ctn and central lymph node metastasis are independent risk factors for cervical lymph node metastasis of MTC,and Ctn can be used as a sensitivity index for predicting cervical lymph node metastasis.

关 键 词：甲状腺髓样癌 降钙素 颈侧区淋巴结转移 危险因素 

分 类 号：R736.1[医药卫生—肿瘤]