甲状腺微小乳头状癌发生颈部中央区淋巴结微转移的危险因素分析  

Risk factors for the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma

作　　者：岳灿 胡海平 姜勇[3] 商雷 马步云[1] YUE Can;HU Haiping;JIANG Yong;SHANG Lei;MA Buyun(Department of Ultrasound Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Department of Ultrasound Medicine,Longchang People's Hospital,Longchang,Sichuan 642150,P.R.China;Department of Pathology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院超声医学科,成都610041 [2]隆昌市人民医院超声医学科,四川隆昌642150 [3]四川大学华西医院病理科,成都610041

出　　处：《华西医学》2023年第3期438-443,共6页West China Medical Journal

基　　金：四川省科学技术厅科技计划项目(2018RZ0138)。

摘　　要：目的探讨甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)发生颈部中央区淋巴结微转移的危险因素。方法回顾性收集2014年1月—2018年12月在四川大学华西医院行外科手术,术前超声未发现颈部中央区淋巴结转移的PTMC患者,术中行患侧颈部中央区淋巴结清扫或患侧颈部中央区加颈侧区淋巴结清扫术。以术后病理为金标准,将患者分为颈部中央区淋巴结微转移组(微转移组)和颈部中央区淋巴结无转移组(无转移组)。比较两组在临床特征及超声征象的差异。结果共纳入患者507例,其中微转移组223例(44.0%),无转移组284例(56.0%)。单因素分析结果显示,与无转移组比较,微转移组患者的年龄较小,男性较多,结节最大径与结节体积偏大,结节呈多灶性、累及双侧叶、侵及甲状腺被膜的比例较高(P<0.05)。多因素logistic回归分析显示,年龄较小[比值比(odds radio,OR)=0.967,95%置信区间(confidence interval,CI)(0.949,0.985),P<0.001]、男性[OR=2.357,95%CI(1.503,3.694),P<0.001]、结节最大径较大[OR=1.232,95%CI(1.100,1.379),P<0.001]、结节体积较大[OR=1.031,95%CI(1.008,1.114),P=0.032]、呈多灶性[OR=2.309,95%CI(1.167,4.570),P=0.016]、侵及甲状腺被膜[OR=1.520,95%CI(1.010,2.286),P=0.045]为颈部中央区淋巴结微转移的独立危险因素。结论患者为男性、年龄较小、PTMC结节最大径与结节体积偏大、呈多灶性、侵及甲状腺被膜,是PTMC患者颈部中央区淋巴结微转移的危险因素,通过这些临床及超声征象可为医生临床处理决策提供理论依据。Objective To explore the risk factors the central cervical lymph node micrometastasis of papillary thyroid microcarcinoma(PTMC).Methods sPTMC patients who underwent surgical operations in West China Hospital,Sichuan University between January 2014 and December 2018 were retrospectively enrolled.The patient did not find lymph node metastasis in the central cervical area by preoperative ultrasound.During the operation,the central cervical lymph node of the affected side was dissected or lymph node dissection in the central area of the affected side of the neck plus the lateral area of the neck.With postoperative pathology as the gold standard,patients were divided into central cervical lymph node micrometastasis group(micrometastasis group)and central cervical lymph node non-metastasis group(non-metastasis group).The differences of clinical features and ultrasonic signs between the two groups were analyzed.ResultsA total of 507 patients were included,including 223(44.0%)in the micrometastasis group and 284(56.0%)in the non-metastasis group.The results of univariate analysis showed that compared with the non-metastasis group,the patients in the micrometastasis group were younger,the tumor size were higher,the proportion of male,multifocality,bilateral involvement and thyroid capsular invasion were higher.The results of multiple logistic regression analysis showed that lower age[odds radio(OR)=0.967,95%confidence interval(CI)(0.949,0.985),P<0.001],male[OR=2.357,95%CI(1.503,3.694),P<0.001],a larger maximum diameter of PTMC[OR=1.232,95%CI(1.100,1.379),P<0.001],a larger nodule volume of PTMC[OR=1.031,95%CI(1.008,1.114),P=0.032],multifocal lesion[OR=2.309,95%CI(1.167,4.570),P=0.016]and invasion of the thyroid capsule[OR=1.520,95%CI(1.010,2.286),P=0.045]were independent risk factors for central cervical lymph node micrometastasis.Conclusions The patient's male,young age,PTMC nodule with large maximum diameter and large volume,multifocal,and invasion of the thyroid membrane are risk factors for the central cervical lymph n

关 键 词：甲状腺微小乳头状癌 超声 颈部中央区淋巴结微转移 

分 类 号：R736.1[医药卫生—肿瘤]