甲状腺微小乳头状癌组织学亚型的临床病理意义及与颈部淋巴结转移的关系  

Clinicopathological significance of histological subtypes in papillary thyroid microcarcinoma and its correlation with cervical lymph node metastasis

作　　者：杨绍时[1] 周扬 柴慈曼 孙宁[1] 王宏[1] 孙宇[1] YANG Shaoshi;ZHOU Yang;CHAI Ciman;SUN Ning;WANG Hong;SUN Yu(Department of Thyroid and Breast Surgery,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院甲状腺乳腺外科,300211

出　　处：《天津医药》2022年第6期638-642,共5页Tianjin Medical Journal

摘　　要：目的探讨甲状腺微小乳头状癌(PTMC)组织学亚型的临床病理意义以及与颈部淋巴结转移的关系。方法回顾性分析行手术切除的1247例PTMC患者的临床病理资料,进行组织学亚型分级及临床病理特征分析,并分析组织学分级与颈部淋巴结转移的关系。结果不同组织类型和分级的PTMC患者在性别、年龄、肿瘤直径、是否伴有桥本甲状腺炎、AJCC分期、肿瘤多灶性、腺叶外受累以及颈部淋巴结转移方面比较差异有统计学意义(均P<0.01)。各亚型中颈部淋巴结转移率分别为高级别亚型(62.64%)>经典乳头型(42.82%)>滤泡型(30.40%)>低级别亚型(8.33%),差异有统计学意义(P<0.01)。多因素分析显示,男性、年龄45岁以下、肿瘤直径≥5 mm、肿瘤多灶性以及高级别组织学亚型是PTMC发生淋巴结转移的独立危险因素,而PTMC中滤泡亚型则是淋巴结转移的独立保护因素(均P<0.05)。结论PTMC组织学亚型具有不同的临床病理特征且是发生颈部淋巴结转移的重要影响因素,进一步评估其组织形态分级对临床治疗策略具有帮助。Objective microcarcinoma(PTMC)and its correlation with cervical lymph node metastasis.Methods The clinicopathological features of 1247 patients with PTMC who underwent surgical resection were retrospectively reviewed,and the correlation between histological subtypes of PTMC and cervical lymph node metastasis was analyzed.Results differences in gender,age,tumor size,Hashimoto thyroiditis,tumor multifocality,extrathyroidal extension and cervical lymph node metastasis of patients with PTMC between different histological subtypes(P<0.01).The cervical lymph node metastasis rate in PTMC was 41.2%.And the cervical metastasis rate was high-grade subtype(62.64%)>classic papillary type(42.82%)>follicular type(30.40%)>low-grade subtype(8.33%),with significant differences between the groups(P<0.01).Logistic analysis showed that male,age under 45 years,tumor size≥5 mm,tumor multifocality and high-grade histological subtypes were independent risk factors for cervical lymph node metastasis(all P<0.05),while follicularsubtypes were independent protective factors for lymph node metastasis in PTMC(P<0.05).Conclusion The histologicalsubtypes of PTMC are closely related to the high-risk pathological features and cervical lymph node metastasis.Furtherevaluation of histological subtypes is helpful for clinical treatment strategy.

关 键 词：甲状腺肿瘤 癌 乳头状 淋巴转移 甲状腺微小乳头状癌 组织学亚型 临床病理参数 

分 类 号：R736.1[医药卫生—肿瘤]