甲状腺乳头状癌颈侧区淋巴结跳跃性转移危险因素分析

Analysis of risk factors for skip lateral lymph node metastasis in papillary thyroid carcinoma

目的探讨甲状腺乳头状癌(PTC)病人颈侧区淋巴结跳跃性转移的规律(中央区淋巴结无转移而颈侧区淋巴结有转移)及其主要危险因素。方法回顾性分析2017年1月至2019年10月就诊于郑州大学第一附属医院甲状腺外科行手术治疗并经术后病理学检查证实有侧区淋巴结转移的275例PTC病人的临床资料,分析跳跃性转移的危险因素。结果颈侧区淋巴结跳跃性转移的发生率为13.1%(36/275),肿瘤位于上极(OR 2.780,95%CI 1.270~6.083;P=0.011),年龄(OR 1.077,95%CI 1.039~1.116;P<0.001),单侧癌(OR 2.459,95%CI 1.094~5.529;P<0.001)是PTC病人出现跳跃性转移的独立危险因素。ROC曲线显示,预测跳跃性转移的最佳年龄界值为48.5岁(敏感度=0.556,特异度=0.753,曲线下面积=0.680,P=0.001)。跳跃性转移病人检出的中央区淋巴结个数及颈侧区淋巴结转移个数与非跳跃性转移病人相比均较少。结论PTC病人颈侧区淋巴结跳跃性转移并不少见,对肿瘤位于腺体上极,年龄≥48.5岁,单侧癌的病人应仔细评估,必要时可行颈侧区淋巴结清扫术。

Objective To investigate the skip lateral lymph node metastasis(lateral lymph node metastasis without central lymph node metastasis)in patients with papillary thyroid carcinoma(PTC)and its main risk factors.Methods The clinical data of 275 patients undergoing surgical treatment who had pathologically confirmed PTC and lateral cervical lymph metastasis in Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University from January 2017 to October 2019 were analyzed retrospectively.The risk factors of skip lateral lymph node metastasis were analyzed.Results Skip metastasis rate of PTC was 13.1%(36/275),tumor located in the upper pole(OR=2.780,95%CI 1.270-6.083;P=0.011),age(OR=1.077,95%CI 1.039-1.116;P<0.001)and unilateral carcinoma(OR=2.459,95%CI 1.094-5.529;P<0.001)were independent risk factors of skip metastasis.The ROC curves showed that the cut-of value of age for predicting skip metastasis was 48.5 years old[sensitivity=0.556,specificity=0.753,area under the curve(AUC)=0.680,P=0.001].The number of lymph nodes detected in the central region and the number of lymph node metastases in the lateral cervical region were significantly less in patients with skip lateral lymph node metastasis compared to patients without skip lateral lymph node metastasis.Conclusion Skip lateral lymph node metastasis is not uncommon for PTC patients.Patients older than 48.5 years old with tumors located in the upper pole of the gland and unilateral carcinoma should be carefully evaluated,if necessary,lateral lymph node dissection should be performed.