1988例甲状腺微小乳头状癌颈部中央区淋巴结转移危险因素分析

Risk Factors for central lymph node metastasis in 1 988 papillary thyroid microcarcinoma patients

目的:探讨1988例甲状腺微小乳头状癌(PTMC)颈部中央区淋巴结转移的危险因素。方法:回顾性分析新疆医科大学附属肿瘤医院2010-01-2016-03期间初治的PTMC癌患者的临床病理特征,通过χ~2检验、多因素统计分析,探讨颈部中央区淋巴结转移的危险因素。结果:颈部中央区淋巴结转移率为34.9%。单因素分析显示,确诊年龄<45岁、男性、多灶、肿瘤位于双侧腺叶(含峡部)、肿瘤直径>5mm、包膜浸润、包膜外侵犯是颈部中央区淋巴结转移的危险因素(P<0.05);多因素分析显示,男性、确诊年龄<45岁、肿瘤直径>5mm、包膜浸润、包膜外侵犯是影响颈部中央区淋巴结转移的独立危险因素。肿瘤位置是单灶颈部中央区淋巴结转移的独立危险因素,其中单灶位于腺叶下极者中央区淋巴结转移率最高(46.8%);而多灶肿瘤位置与中央区淋巴结转移无关(P>0.05)。结论:当PTMC患者存在以下情况:男性、确诊年龄<45岁、肿瘤直径>5mm、包膜浸润、包膜外侵犯,单灶位于腺叶下极时,应警惕淋巴结转移可能,建议行积极诊治方案以及更加密切的术后随访。

Objective：To determine the risk factors that increase the neck central lymph node metastasis in papillary thyroid microcarcinoma（PTMC）.Method：In this retrospective study,clinical and pathologic data were collected from patients who were first diagnosed as PTMC at the Xinjiang Medical University affiliated Tumor Hospital from January 2010 to March 2016.Chi-square test and multivariate logistic regression analysis were used to identify the risk factors of the neck central lymph node metastasis.Result：Of all 1988 patients,34.9% had the neck central lymph node metastasis.Age〈45 years（P〈0.05）,male（P〈0.05,）,multifocality（P〈0.05）,bilaterality（P〈0.05）,tumor size〉5 mm（P〈0.05）,capsular invasion（P〈0.05）or extrathyroidal extension（P〈0.05）were significantly correlated with the neck central lymph node metastasis.Multivariate logistic regression analysis indicated that male,age 〈45 years,tumor size 〉5 mm,capsular invasion,extrathyroidal extension were independently correlated with the neck central lymph node metastasis.For patients with a solitary primary tumor,tumor location was independently correlated with the neck central lymph node metastasis.Unifocal tumor location in the lower third of the thyroid lobe was associated with the highest risk of the neck central lymph node metastasis（46.8%）（P〈0.05）.Multifocal tumor location was not associated with the neck central lymph node metastasis（P〉0.05）.Conclusion：More aggressive treatment or more frequent follow-up could be considered for patients with unfavorable features（male gender,age 〈45 years,tumor size 〉5mm,capsular invasion,extrathyroidal extension,unifocal tumor location in the lower third of the thyroid lobe）,as these patients may be at an increased risk for the neck central lymph node metastasis.