最大径≤4 cm甲状腺滤泡性肿瘤恶性风险预测因素的多因素分析  

Multivariate Analysis on Predictive Factors of Malignant Risk for Follicular Thyroid Neoplasms With a Maximum Diameter≤4 cm

作　　者：李欣[1] 姚响芸[2] 梅放[3] 于波 黄九平 宋世兵[1] Li Xin;Yao Xiangyun;Mei Fang(Department of General Surgery,Peking University Third Hospital,Beijing 100191,China;不详)

机构地区：[1]北京大学第三医院普通外科,北京100191 [2]北京大学第三医院超声医学科,北京100191 [3]北京大学第三医院病理科,北京100191

出　　处：《中国微创外科杂志》2025年第3期129-134,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨最大径≤4 cm的甲状腺滤泡性肿瘤(follicular thyroid neoplasms,FTN)恶性风险的预测因素,为FTN患者的术前诊断及个体化治疗提供依据。方法回顾性分析2018年1月~2023年12月我院收治的肿瘤最大径≤4 cm的FTN患者的临床资料。根据术后病理诊断将患者分为甲状腺滤泡癌(follicular thyroid carcinoma,FTC)组和甲状腺滤泡性腺瘤(follicular thyroid adenoma,FTA)组,通过单因素分析和多因素logistic回归分析,探讨FTN恶性风险的预测因素。结果共纳入870例,FTA组745例(85.6%),FTC组125例(14.4%)。单因素分析显示,年龄、性别、BMI、是否合并桥本氏甲状腺炎、结节数量和位置、结节最大径、结节内部结构和内部血流信号差异无显著性(P>0.05),结节回声、边缘、声晕、纵横比和钙化差异有显著性(P<0.05)。多因素logistic回归分析显示,结节边缘不规则(OR=3.061,95%CI:1.653~5.667,P=0.000)、不等厚声晕(OR=5.868,95%CI:1.258~27.377,P=0.024)和边缘弧形钙化(OR=4.364,95%CI:1.329~14.333,P=0.015)是FTN恶性风险的预测因素。结论超声征象对评价FTN的良恶性有一定的价值,对结节边缘、声晕和钙化的仔细评估,能够促进较小FTN的早期诊断和治疗。Objective To investigate predictive factors of malignant risk for follicular thyroid neoplasms(FTN)with a maximum diameter≤4 cm,providing evidence for preoperative diagnosis and individualized treatment for FTN patients.Methods We retrospectively analyzed clinical data of FTN patients with a maximum tumor diameter≤4 cm treated at our hospital between January 2018 and December 2023.Based on postoperative pathological diagnosis,the patients were divided into follicular thyroid carcinoma(FTC)group and follicular thyroid adenoma(FTA)group.Univariate and multivariate logistic regression analyses were performed to explore predictive factors of malignant risk of FTN.Results A total of 870 patients were included,comprising of 745 patients(85.6%)in the FTA group and 125 patients(14.4%)in the FTC group.The univariate analysis showed that age,gender,BMI,comorbidity of Hashimoto’s thyroiditis,number and location of nodules,the maximum diameter of nodules,internal structure of nodules,and internal blood flow signals had no significant differences(P>0.05),while nodule echogenicity,margins,halo,taller-than-wide shape,and calcification had significant differences(P<0.05).Multivariate logistic regression analysis revealed that irregular margins(OR=3.061,95%CI:1.653-5.667,P=0.000),uneven thickness of the halo(OR=5.868,95%CI:1.258-27.377,P=0.024),and peripheral rim calcification(OR=4.364,95%CI:1.329-14.333,P=0.015)were predictive factors of malignant risk for FTC.Conclusions Ultrasound features have certain value for evaluating benign or malignant nature of FTN.Careful assessment of nodule margins,halo,and calcification can facilitate early diagnosis and treatment of small FTN.

关 键 词：甲状腺滤泡性肿瘤 超声 甲状腺滤泡癌 甲状腺滤泡性腺瘤 预测因素 

分 类 号：R73[医药卫生—肿瘤]