甲状腺乳头状癌颈中线淋巴结分区预测对侧中央区淋巴结转移情况的价值研究  

The value of cervical midline lymph nodes subdivison in predicting the contralateral central lymph nodes metastasis in papillary thyroid carcinoma

作　　者：徐国建[1] 邹岚[1] 王威 XU Guo-jian;ZOU La;WANG Wei(Department of Vascular and Thyroid Surgery,Foshan First Peoples Hospital,Foshan,Guangdong Province 528000,China)

机构地区：[1]佛山市第一人民医院血管甲状腺外科,广东佛山528000

出　　处：《解剖学研究》2024年第3期242-247,共6页Anatomy Research

基　　金：佛山市自筹经费类科技计划项目(2020001005269)。

摘　　要：目的分析甲状腺乳头状癌(PTC)患者对侧中央区淋巴结(Cont-CLNs)转移的相关因素,评估颈中线淋巴结(Mid-CLNs)分区在识别Cont-CLNs转移中的临床价值。方法选取2021年1月至2023年6月广东省佛山市第一人民医院进行甲状腺全切除术和双侧中央区颈淋巴清扫术(CND)治疗PTC的125例患者,组织病理学检查评估的主要因素包括:原发肿瘤最大直径、多灶性、被膜侵犯、腺外浸润、桥本氏甲状腺炎、淋巴结转移分区。组间数据比较采用单因素方差分析。利用多因素Logistic回归分析法分析Cont-CLNs转移的危险因素,计算受试者工作特征(ROC)曲线下面积,分析对侧Mid-CLNs转移对Cont-CLNs转移的预测效能。结果125例PTC患者中,107(85.60%)例患者发生Mid-CLNs转移,57.60%(72/125)的患者发生患侧Mid-CLNs转移,28.80%(36/125)的患者发生对侧Mid-CLNs转移。在单因素分析中,多灶性(P=0.004)、被膜侵犯(P=0.002)、腺外浸润(P=0.048)、对侧Mid-CLNs转移(P<0.01)和Ipis-CLNs转移(P=0.043)与Cont-CLNs转移的发生有显著相关性。而Mid-CLNs转移(P=0.422)、患侧Mid-CLNs转移(P=0.856)与Cont-CLNs转移的发生则无相关性。多因素Logistic回归分析发现,Ipis-CLNs转移(P=0.013,OR=2.065)和对侧Mid-CLNs转移(P=0.008,OR=2.072)发生越多,Cont-CLNs转移发生的概率越大。且对侧Mid-CLNs转移阳性对Cont-CLNs转移预测的AUC为0.664(95%CI=0.554~0.774,P=0.006),敏感度为76.19%,特异度为56.60%。结论对侧Mid-CLNs转移是Cont-CLNs转移的独立危险因素,且对预测Cont-CLNs转移具有较为良好的诊断价值。Objective To analyze the factors associated with contralateral central lymph nodes(Cont⁃CLNs)metastasis in patients with papillary thyroid carcinoma(PTC),and to evaluate the clinical value of midline cervical lymph nodes(Mid⁃CLNs)segmentation in the identification of Cont⁃CLNs metastasis.Methods A total of 125 patients with PTC who underwent total thyroidectomy and bilateral central neck dissection(CND)in The First Peoples Hospital of Foshan City,Guangdong Province from January 2021 to June 2023 were selected.The main fac⁃tors evaluated by histopathological examination included:maximum diameter of primary tumor,multifocality,cap⁃sule invasion,extrathyroidal invasion,Hashimotos thyroiditis,and lymph node metastasis level.One⁃way analysis of variance was used to compare the data between groups.Multivariate Logistic regression analysis was used to ana⁃lyze the risk factors of Cont⁃CLNs metastasis,and the area under the receiver operating characteristic(ROC)curve was calculated to analyze the predictive efficacy of contralateral Mid⁃CLNs metastasis for Cont⁃CLNs metastasis.Re⁃sults Among 125 patients with PTC,107(85.60%)patients had Mid⁃CLNs metastasis,57.60%(72/125)pa⁃tients had ipsilateral Mid⁃CLNs metastasis,and 28.80%(36/125)patients had contralateral Mid⁃CLNs metastasis.In univariate analysis,multiple lesions(P=0.004),capsule invasion(P=0.002),extrathyroidal invasion(P=0.048),contralateral Mid⁃CLNs metastasis(P<0.01)and iDIS⁃CLNs metastasis(P=0.043)were significantly corre⁃lated with Cont⁃CLNs metastasis.There was no correlation between Mid⁃CLNs metastasis(P=0.422),Mid⁃CLNs me⁃tastasis(P=0.856)on the affected side and Cont⁃CLNs metastasis.Multivariate Logistic regression analysis showed that the more iDIS⁃CLNs metastasis(P=0.013,OR=2.065)and contralateral Mid⁃CLNs metastasis(P=0.008,OR=2.072),the greater the probability of Cont⁃CLNs metastasis.The AUC of contralateral Mid⁃CLNs metastasis in pre⁃dicting Cont⁃CLNs metastasis was 0.664(95%CI=0.554-0.774,P=0.

关 键 词：甲状腺乳头状癌 颈淋巴结 分区 甲状腺全切除术 相关性 

分 类 号：R736.1[医药卫生—肿瘤]