1401例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析

Clinicopathological features and risk factors for central compartment nodal metastasis in papillary thyroid microcarcinoma: a study of 1 401 patients

目的：探讨甲状腺微小乳头状癌 （papillary thyroid microcarcinoma, PTMC ）患者的临床病理特征及中央区淋巴结转移的危险因素。方法：回顾性分析2014年1月至2014年12月天津医科大学肿瘤医院甲状腺颈部肿瘤科收治的1401例具有完整病例资料的甲状腺微小乳头状癌患者临床病理特征，应用X2检验和多因素Logistic回归模型分析中央区淋巴结转移的危险因素。结果：临床病理特征方面，PTMC男女性别比约1：3．4，其中央区淋巴结转移率为30．5％。单因素分析显示发病年龄（x2=14．587，P〈0．01）、性别（X2=21．636，P〈0．01）、原发灶数目（X2=35．505，P〈0．01）、肿瘤最大直径（X2=58．868，P〈0．01）、肿瘤位置（x2=8．385，P〈0．05）及被膜外腺外侵犯（X2=26．481，P〈0．01）均与中央区淋巴结转移有显著性差异。肿瘤处于甲状腺下极时，中央区淋巴结转移率最高（48．1％）。多因素Logistic回归分析显示男性、年龄〈45岁、肿瘤直径〉6mm、被膜外腺外侵犯及双侧多发癌灶为PTMC患者中央区淋巴结转移的独立危险因素。结论：具备男性、年龄〈45岁、肿瘤直径〉6min、腺外侵犯及双侧甲状腺受累等特征的PTMC患者较易发生中央区淋巴结转移，建议行预防性中央区淋巴结清扫。

Objective： To determine the clinical features of papillary thyroid microcarcinoma （PTMC） and the risk factors for central compartment lymph node （CCLN） metastasis in PTMC. Methods： Data of 1 401 patients with PTMC who were treated in Tianjin Medi- ca~ University Cancer Institute and Hospital between January 2014 and December 2014 were retrospectively analyzed. Chi-square test and multivariate Logistic regression analysis were used to study the risk factors. Results： With regard to clinicopathological features, the sex ratio is 1：3.4 in patients with PTMC. CCLN metastasis affected 427 （30.5%） of the total 1 401 patients. Age （X2= 14.587, P〈0.01）, sex （X2= 21.636, P〈0.01）, tumor multifocality （X2=35.505, P〈0.01）, tumor size （X2= 58.868, P〈0.01）, tumor site （X2=8.385, P〈0.05）, and extracapsular/extraglandular invasions （X2=26.481, P〈0.01） were significantly correlated with CCLN metastasis. For patients with a soli- tary primary tumor, tumor location in the lower third of the thyroid lobe was associated with a higher risk of CCLN metastasis （48.1%）. The male gender, age 〈45 years, tumor size 〉6 mm, extracapsular spread, and tumor bilaterality were independently correlated with CCLN metastasis. Conclusion： A prophylactic neck dissection of the central compartment must be considered particularly in male PT- MC patients with age 〈45 years, tumor size 〉 6 mm, extracapsular spread, and tumor bilaterality.