多灶性甲状腺微小乳头状癌进行主动监测的可行性探讨  

Feasibility of active surveillance for multifocal papillary thyroid microcarcinoma

作　　者：杨广祥 王蓉[1] 刘月 Yang Guangxiang;Wang Rong;Liu Yue(Department of Health Management Center,the Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China;Department of Ultrasound,the Affiliated Zhongshan Hospital of Dalian University,Dalian 116001,China)

机构地区：[1]大连大学附属中山医院健康管理中心,大连116001 [2]大连大学附属中山医院超声科,大连116001

出　　处：《中华健康管理学杂志》2025年第2期106-111,共6页Chinese Journal of Health Management

摘　　要：目的探讨多灶性甲状腺微小乳头状癌(PTMC)进行主动监测(AS)的可行性。方法本研究为横断面研究,回顾性分析2017年3月至2023年12月大连大学附属中山医院健康管理中心共124580例体检者的甲状腺超声检查资料,根据PTMC的个数分为单发性PTMC与多灶性PTMC,应用Kaplan-Meier法及Log-Rank检验比较AS期间单发性与多灶性PTMC增长率、淋巴结转移率及进展率差异。根据PTMC进行AS的结局分为进展组与非进展组,比较进展组与非进展组患者的基本临床特征,采用Cox比例风险回归分析PTMC进展的危险因素。结果纳入研究的304例PTMC患者中,其中单发性PTMC 239例,多灶性PTMC 65例。AS期间单发性与多灶性PTMC增长率、颈部淋巴结转移率与进展率比较差异均无统计学意义。AS期间PTMC共有47例进展,257例未进展,进展率为15.5%,进展组与非进展组患者的初诊年龄比较差异有统计学意义。多因素回归分析结果显示初诊年龄是PTMC进展的唯一危险因素,初诊年龄每增加1岁,其进展的风险降低0.079[HR=0.921(95%CI:0.888~0.955),P<0.001],多灶性不是PTMC进展的危险因素[HR=1.973(95%CI:0.972~4.462),P=0.103]。结论对适当年龄的多灶性PTMC患者可进行AS。ObjectiveTo explore the feasibility of active surveillance for multifocal papillary thyroid microcarcinoma(PTMC).MethodsIt was a cross-sectional study.The thyroid ultrasonography data from 124580 health check-up participants in the Health Management Center at the Affiliated Zhongshan Hospital of Dalian University between March 2017 and December 2023 were retrospectively analyzed.The patients were divided into unifocal or multifocal group according to the number of PTMC.The rates of growth,lymph node metastasis and progression in the unifocal and multifocal PTMC group during active surveillance were compared by using the Kaplan-Meier method and the log-rank test.The patients were divided into the group of progression or no-progression according to the outcome of active surveillance,and the basic clinical characteristics between the groups were compared.The Cox proportional hazards regression analysis was used to identify the risk factors for the progression of PTMC.ResultsA total of 304 patients were enrolled in this study,among them,there were 239 cases of unifocal PTMC and 65 cases of multifocal PTMC.There was no significant differences in the rates of growth,lymph node metastasis and progression in the PTMC between the two groups during active surveillance(all P>0.05).During the active surveillance period,a total of 47 cases of PTMC progressed,while 257 cases did not.The progression rate was 15.5%.There was statistically significant difference in the initial age of PTMC diagnosis between the progression and non-progression group(P<0.05).Multivariate regression analysis showed that age of initial diagnosis was the only risk factor for the progression of PTMC,the risk of progression decreased by 0.079 for every one-year increase in the initial diagnosis age[HR=0.921,(95%CI:0.888-0.955),P<0.001],multifocality was not a risk factor[HR=1.973,95%CI(0.972-4.462),P=0.103].ConclusionActive surveillance can be performed for multifocal PTMC in patients of appropriate age.

关 键 词：多灶性 甲状腺微小乳头癌 主动监测 进展 

分 类 号：R73[医药卫生—肿瘤]