中下极甲状腺乳头状癌颈部淋巴结跳跃转移危险因素分析  

Risk factors analysis of cervical lymph node skip metastasis in the middle and lower pole papillary thyroid carcinoma

作　　者：倪萍 章双艳 颜子玲 黄驰 马丙娥 王建华[1] NI Ping;ZHANG Shuangyan;YAN Ziling;HUANG Chi;MA Bing'e;WANG Jianhua(Department of Thyroid and Breast Surgery,Jiangsu Province Hospital with Integration of Chinese and Western Medicine,Nanjing 210028,China)

机构地区：[1]江苏省中西医结合医院甲乳外科,江苏南京210028

出　　处：《中国肿瘤外科杂志》2024年第4期318-323,共6页Chinese Journal of Surgical Oncology

基　　金：江苏省中医药管理局项目(JD2023SZX03)。

摘　　要：目的探讨中下极甲状腺乳头状癌(PTC)患者颈部淋巴结跳跃性转移的临床特征及危险因素。方法收集2022年1月至2023年12月于江苏省中西医结合医院接受甲状腺叶切除术及中央+颈侧区淋巴结清扫术的PTC患者资料,分析肿瘤位置位于腺叶中下极PTC患者淋巴结跳跃性转移的临床特征及危险因素。受试者工作(ROC)曲线用于分析年龄的最佳截断值。结果中下极PTC发生颈部淋巴结跳跃转移者15例,跳跃性转移的发生率为11.45%(15/131)。颈侧Ⅲ区和Ⅳ区在单区和二区转移中最为多见。年龄(OR=1.143,95%CI:1.055~1.238,P=0.001)、肿瘤最大径≤1 cm(OR=0.086,95%CI:0.014~0.515,P=0.007),TSH较低(OR=0.403,95%CI:0.168~0.967,P=0.042)是中下极PTC跳跃转移的独立危险因素。中央区淋巴结清扫数目(OR=0.858,95%CI:0.741~0.994,P=0.041),颈侧区淋巴结转移数目(OR=0.520,95%CI:0.286~0.891,P=0.018)增加与中下极PTC淋巴结跳跃转移呈负相关。根据ROC曲线显示,预测跳跃转移的最佳年龄截断值为35.5岁(敏感度=93.3%,特异度=41.4%,曲线下面积=0.816,95%CI:0.717~0.915,P<0.001)。结论中下极PTC淋巴结跳跃性转移并不少见,当患者肿瘤位置位于中下极,年龄>33.5岁,超声提示肿瘤最大径≤1 cm时,术前应对患者颈侧Ⅲ+Ⅳ区淋巴结转移情况进行更细致地评估,必要时可术前复核B超。Objective This study aims to explore the clinical characteristics and risk factors of cervical lymph node skip metastasis in the middle and lower pole papillary thyroid carcinoma(PTC)patients.Methods The study retrospectively analyzed the data of PTC patients who underwent thyroid lobectomy and central plus lateral cervical lymph node dissection in Jiangsu Province Hospital with Integration of Chinese and Western Medicine from January 2022 to December 2023.The clinical characteristics and risk factors of skip metastasis in the middle and lower pole PTC patients were analyzed.Receiver operating characteristic(ROC)curve was used to determine the optimal cutoff value of age.Results Among the 131 PTC patients in this study,cervical lymph node skip metastasis occurred in 15 cases(11.45%)with the middle and lower pole PTC.TheⅢandⅣcervical lymph node areas were the most common sites of metastasis in single or double areas.Age(OR=1.143,95%CI:1.055⁃1.238,P=0.001),tumor maximum diameter≤1 cm(OR=0.086,95%CI:0.014⁃0.515,P=0.007),and low TSH(OR=0.403,95%CI:0.168⁃0.967,P=0.042)were independent risk factors for skip metastasis in the middle and lower pole PTC.The number of central cervical lymph node dissection(OR=0.858,95%CI:0.741⁃0.994,P=0.041)and lateral cervical lymph node metastasis(OR=0.520,95%CI:0.286⁃0.891,P=0.018)were negatively correlated with skip metastasis in the middle and lower pole PTC.According to the ROC curve,the optimal age cutoff value for predicting skip metastasis was 35.5 years old(sensitivity=93.3%,specificity=41.4%,AUC=0.816,95%CI:0.717⁃0.915,P<0.001).Conclusions Skip metastasis in the middle and lower pole PTC is not uncommon.When the patients tumor is located in the middle and lower pole,the age is over 33.5 years old,and B⁃ultrasound indicates that the maximum diameter of the tumor is≤1 cm,a more detailed evaluation of the lymph node metastasis in neck sideⅢ+Ⅳshould be performed before surgery,and B⁃ultrasound may need to be reviewed again before surgery if necessary.

关 键 词：甲状腺乳头状癌 跳跃性转移 淋巴结转移 颈侧区 

分 类 号：R736.1[医药卫生—肿瘤]