甲状腺乳头状癌侧颈部淋巴结跳跃性转移的危险因素  

Risk factors for skip metastasis to lateral cervical lymph nodes in papillary thyroid cancer

作　　者：张梦夏 赵玮[1] 郭雪冉 史良平 夏梦华 毕丽琴 程义壮 ZHANG Mengxia;ZHAO Wei;GUO Xueran;SHI Liangping;XIA Menghua;BI Liqin;CHENG Yizhuang(Department of Nuclear Medicine,West District of the First Affiliated Hospital of University of Science and Technology of China,Anhui Province Cancer Hospital,Hefei 230031,China)

机构地区：[1]中国科学技术大学附属第一医院西区,安徽省肿瘤医院核医学科,合肥230031

出　　处：《临床与病理杂志》2024年第2期251-260,共10页Journal of Clinical and Pathological Research

摘　　要：目的:探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)侧颈部淋巴结跳跃性转移的相关危险因素,建立预测PTC患者发生侧颈部淋巴结跳跃性转移风险的列线图,以帮助制订合理的手术计划。方法:收集2020年1月至2021年12月在中国科学技术大学附属第一医院行甲状腺全切除术和中央淋巴结清扫术(central lymph node dissection,CLND)加侧颈部淋巴结清扫术(lateral lymph node dissection,LLND)的209例PTC患者的临床资料,分析侧颈部淋巴结跳跃性转移与PTC患者临床病理特征及术前相关检查指标的关系。寻找年龄和超声下优势结节直径的最佳临界值,并绘制风险预测模型列线图。结果:侧颈部淋巴结跳跃性转移发生率为12.9%(27/209)。临床病理及术前检查特征的单因素分析显示:侧颈部淋巴结跳跃性转移与年龄、肿瘤病灶位置、肿瘤直径、中央淋巴结清扫数目、侧颈部淋巴结转移数目、超声下优势结节直径大小、超声提示肿瘤边缘粗糙及超声提示甲状腺外侵犯有关(均P<0.05)。多因素回归分析显示:年龄(OR=1.061,P=0.003)、超声下结节直径大小(OR=0.874,P=0.003)、肿瘤位于上部位置(OR=2.874,P=0.035)、超声提示肿瘤边缘粗糙(OR=0.118,P=0.044)及超声提示甲状腺外侵犯(OR=0.287,P=0.013)是侧颈部淋巴结跳跃性转移的独立预测因素。年龄为38.5岁、超声下结节直径<9.5 mm对预测侧颈部淋巴结跳跃性转移具有最大的预测价值。结论:年龄>38.5岁、肿瘤位于上部位置、超声下结节直径<9.5 mm、超声提示结节边缘粗糙及超声提示甲状腺外侵犯的PTC患者易出现侧颈部淋巴结跳跃性转移。本研究根据相关独立危险因素建立的预测PTC患者发生跳跃性转移风险的列线图,可有效帮助临床医生术前评估PTC发生跳跃性转移的风险。Objective:To explore the risk factors associated with skip metastasis to lateral cervical lymph nodes in papillary thyroid carcinoma(PTC),establish a nomogram for predicting the risk of skip metastasis in patients with PTC,and thereby assist in devising a rational surgical plan.Methods:Clinical data from 209 PTC patients who underwent total thyroidectomy and central lymph node dissection(CLND)along with lateral lymph node dissection(LLND)at the First Affiliated Hospital of University of Science and Technology of China from January 2020 to December 2021 were collected.The relationship between skip metastasis to lateral cervical lymph nodes and clinical pathological characteristics of the patients,as well as preoperative related examination indicators,were analyzed.The optimal cutoff values for age and ultrasound dominant nodule diameter were identified,and a risk prediction nomogram was constructed.Results:The incidence of skip metastasis to lateral cervical lymph nodes was 12.9%(27/209).Univariate analysis of clinicopathology and preoperative characteristics showed that skip metastasis was significantly associated with age,location of tumor lesion,tumor diameter,number of central lymph nodes dissection,number of lateral cervical lymph node metastasis,diameter of the dominant nodule under ultrasound,ultrasound indications of rough tumor margins,and ultrasound indications of external thyroid invasion(all P<0.05).Multivariate regression analysis showed that age(OR=1.061,P=0.003),the diameter of the nodule under ultrasound(OR=0.874,P=0.003),the location of the tumor in the upper position(OR=2.874,P=0.035),ultrasound-indicated rough tumor margins(OR=0.118,P=0.044),and ultrasound indications of external thyroid invasion(OR=0.287,P=0.013)were independent predictors of skip metastasis to lateral cervical lymph nodes.Age was 38.5 years and the ultrasound nodule diameter was less than 9.5 mm had the greatest predictive value for skip metastasis.Conclusion:PTC patients older than 38.5 years with tumors located in the upper

关 键 词：甲状腺乳头状癌 跳跃性转移 侧颈部淋巴结转移 危险因素 列线图 

分 类 号：R736.1[医药卫生—肿瘤]