645例初治甲状腺乳头状癌患者气管周围淋巴结转移的危险因素分析  

Analysis of risk factors for tracheal lymph node metastasis in 645 patients with newly diagnosed papillary thyroid carcinoma

作　　者：辅容 陆辉[1] 杭菁[2] 施杲旸 FU Rong;LU Hui;HANG Jing;SHI Gaoyang(Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Ultrasound Diagnosis,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院普外科,江苏南京210029 [2]南京医科大学第一附属医院超声诊断科,江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2023年第12期1681-1685,共5页Journal of Nanjing Medical University(Natural Sciences)

基　　金：江苏省卫健委医学科研面上项目(M2022027)。

摘　　要：目的:评估并分析甲状腺乳头状癌气管周围淋巴结转移相关危险因素,以及喉前淋巴结对气管周围淋巴结转移的预测能力。方法:回顾性分析本院645例因甲状腺乳头状癌行手术治疗的患者资料。按照中国甲状腺癌诊疗指南(2022年版)推荐的手术指征和切除范围,根据术前触诊、超声检查和穿刺病理的结果行甲状腺切除和淋巴结清扫术。结果:645例中,215例(33.3%)术后病理证实气管周围淋巴结转移。单因素分析提示气管周围淋巴结转移与年龄<45岁、癌灶最大径≥1 cm、腺内播散、腺外侵犯、多发灶、癌灶累及双叶、喉前淋巴结转移有关。多因素分析提示年龄<45岁、喉前淋巴结转移是气管周围淋巴结转移的独立危险因素。喉前淋巴结转移对气管周围淋巴结转移的灵敏度、特异度、阳性预测值、阴性预测值、准确度分别为21.4%、93.7%、63.0%、70.5%、69.6%。结论:在年轻、喉前淋巴结转移的甲状腺乳头状癌患者中要仔细评估气管周围淋巴结情况。喉前淋巴结转移对气管周围淋巴结转移有一定预测作用,评估喉前淋巴结有助于制定气管周围淋巴结处理策略,但目前仍需要更多循证医学证据以帮助临床医生更好地决策。Objective:To evaluate and analyze the risk factors associated with tracheal lymph node metastasis in patients with papillary thyroid carcinoma(PTC),as well as the predictive ability of pretracheal lymph node involvement for tracheal lymph node metastasis.Methods:A retrospective analysis was conducted on the data of 645 patients who underwent surgical treatment for PTC in our hospital.According to the surgical indications and resection scope recommended in the Chinese Thyroid Cancer Diagnosis and Treatment Guidelines(2022 edition),thyroidectomy and lymph node dissection were performed based on preoperative palpation,ultrasound examination,and fine⁃needle aspiration biopsy results.Results:Among the 645 cases,215 cases(33.3%)were pathologically confirmed to have tracheal lymph node metastasis after surgery.Univariate analysis suggested that tracheal lymph node metastasis was associated with age<45 years,maximum tumor diameter≥1 cm,intraglandular spread,extraglandular invasion,multifocal lesions,involvement of both lobes,and pretracheal lymph node metastasis.Multivariate analysis indicated that age<45 years and pretracheal lymph node metastasis were independent risk factors for tracheal lymph node metastasis.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of pretracheal lymph node involvement in predicting tracheal lymph node metastasis were 21.4%,93.7%,63.0%,70.5%,and 69.6%,respectively.Conclusion:In young patients with PTC and pretracheal lymph node metastasis,careful evaluation of tracheal lymph node status is necessary.Pretracheal lymph node involvement has a certain predictive role in tracheal lymph node metastasis.Assessing pretracheal lymph nodes can help formulate strategies for managing tracheal lymph nodes,but more evidence from evidence⁃based medicine is still needed to facilitate better decision⁃making.

关 键 词：甲状腺乳头状癌 喉前淋巴结 气管周围淋巴结 淋巴清扫 

分 类 号：R736.1[医药卫生—肿瘤]