青少年甲状腺乳头状癌的临床病理特征及预后分析  

Clinicopathological characteristics and prognosis of papillary thyroid cancer in adolescents

作　　者：孙玉霄 刘维豪 张逸菲 李红强[1] 唐艺峰[1] 殷德涛[1,2,3] SUN Yuxiao;LIU Weihao;ZHANG Yifei;LI Hongqiang;TANG Yifeng;YIN Detao(Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,P.R.China;Engineering Research Center of Multidisciplinary Diagnosis and Treatment of Thyroid Cancer of Henan Province,Zhengzhou 450052,P.R.China;Key Medicine Laboratory of Thyroid Cancer of Henan Province,Zhengzhou 450052,P.R.China)

机构地区：[1]郑州大学第一附属医院甲状腺外科,郑州450052 [2]河南省甲状腺癌多学科诊疗工程研究中心,郑州450052 [3]河南省甲状腺癌医学重点实验室,郑州450052

出　　处：《中国普外基础与临床杂志》2024年第11期1330-1335,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：河南省自然科学基金面上项目(项目编号:222300420568);河南省医学科技攻关重大计划项目(项目编号:SBGJ202101014);河南省中医药研究重大专项(项目编号:20-21ZYZD14);河南省中青年医学科技创新领军人才项目(项目编号:YXKC2020015)。

摘　　要：目的 总结青少年甲状腺乳头状癌(papillary thyroid,PTC)的临床病理特征并且探索影响颈侧区淋巴结转移及预后的危险因素。方法 回顾性收集2012年1月至2022年1月期间郑州大学第一附属医院甲状腺外科收治且符合纳入和排除标准的150例青少年PTC患者为研究对象(青少年组),并选择100例同期就诊的成人PTC患者为成人组。采用SPSS 25.0软件进行统计学分析,比较2组患者的临床病理特征,并分别采用logistic回归和Cox比例风险回归模型探索青少年PTC患者颈侧区淋巴结转移及复发的危险因素。结果 青少年PTC患者更易发生腺体外侵犯[30.0%(45/150)比17.0%(17/100),P=0.020]、颈部淋巴结转移[79.3%(119/150)比48.0%(48/100),P<0.001]、中央区淋巴结转移[78.7%(118/150)比48.0%(48/100),P<0.001]和颈侧区淋巴结转移[44.0%(66/150)比12.0%(12/100),P<0.001];并且青少年PTC患者的最大肿瘤直径更大(1.75 cm比0.75 cm,P<0.001),最大肿瘤直径>2 cm的比例更高[45.3%(68/150)比8.0%(8/100),P<0.001]。在青少年PTC患者中,腺体外侵犯(OR=2.654,P=0.022)、多病灶(OR=4.860,P<0.001)和最大肿瘤直径>2 cm(OR=3.845,P=0.001)为颈侧区淋巴结转移的危险因素;颈侧区淋巴结转移(RR=10.105,P=0.040)和远处转移(RR=7.058,P=0.003)是青少年PTC患者术后复发的预测因素。结论 与成人PTC患者相比,青少年PTC患者的肿瘤侵袭性较强;存在腺体外侵犯、多病灶和最大肿瘤直径>2 cm的青少年PTC需考虑是否行颈侧区淋巴结清扫术;存在颈侧区淋巴结转移和远处转移的青少年PTC患者需密切关注其复发状况。Objective To summarize the clinicopathological characteristics of papillary thyroid cancer(PTC)in adolescents and analyze the risk factors affecting lateral lymph node metastasis and prognosis.Methods In retrospectively,150 adolescent PTC patients admitted to the Department of Thyroid Surgery of the First Affiliated Hospital of Zhengzhou University from January 2012 to January 2022 and meeting the inclusion and exclusion criterias were collected as the study subjects(adolescent group),and 100 adult PTC patients were selected as adult group.Statistical analysis was performed with SPSS 25.0 software to compare the clinicopathological characteristics of the patients in the two groups,and to explore the risk factors for lateral lymph node metastasis and recurrence in adolescent PTC patients by using logistic regression and Cox proportional hazards regression models, respectively. Results Adolescents with PTCwere more prone to extrandular invasion [30.0% (45/150) versus 17.0% (17/100), P=0.020], neck lymph node metastasis[79.3% (119/150) versus 48.0% (48/100), P<0.001], central lymph node metastasis [78.7% (118/150) versus 48.0% (48/100),P<0.001], lateral lymph node metastasis [44.0% (66/150) versus 12.0% (12/100), P<0.001];and had a greater maximumtumor diameter (1.75 cm versus 0.75 cm, P<0.001) and higher ratio of greater maximum tumor diameter >2 cm [45.3%(68/150) versus 8.0% (8/100), P<0.001] in adolescent PTC patients. In adolescent PTC patients, extraglandular invasion(OR=2.654, P=0.022), multifoci (OR=4.860, P<0.001) and maximum tumor diameter>2 cm (OR=3.845, P=0.001) wererisk factors for lateral lymph node metastasis;lateral lymph node metastasis (RR=10.105, P=0.040) and distant metastasis(RR=7.058, P=0.003) were predictors of postoperative recurrence in adolescent PTC patients. Conclusions Comparedwith adult PTC patients, adolescent PTC patients have more aggressive tumors. Adolescent PTC with extraglandularinvasion, multilesions, and maximum tumor diameter>2 cm should be considered for lateral lymph node dis

关 键 词：甲状腺乳头状癌 青少年 颈侧区淋巴结转移 复发 

分 类 号：R736.1[医药卫生—肿瘤]