甲状腺乳头状癌亚型的临床病理特点及术后复发的影响因素分析

Analysis on the Clinicopathologic Features of Thyroid Papillary Carcinoma Subtype and the Influencing Factors of Postoperative Recurrence

分析甲状腺乳头状癌各亚型的临床病理特点,并分析影响甲状腺乳头状癌术后复发的影响因素。收集2014年1月2017年1月在我院接受治疗的288例甲状腺乳头状癌患者的临床资料和随访记录,分析甲状腺乳头状癌各亚型的临床病理特点,并使用卡方检验和Logistic回归分析影响甲状腺乳头状癌术后复发的危险因素。纳入本研究的288例甲状腺乳头状癌患者中实体亚型45例,占15.63%;滤泡亚型35例,占12.15%,其中非包膜内型28例,包膜内型7例;高细胞亚型20例,占6.94%;弥漫硬化型25例,占8.68%;剩余253例均为经典型,占87.85%。单因素分析结果显示:性别、包膜外侵犯、淋巴结转移、首次手术术式、术后甲状腺素的应用、肿瘤最大直径、TNM分期均与甲状腺乳头状癌的复发相关(P<0.05),年龄和多灶性与甲状腺乳头状癌的复发无关(P>0.05)。Logistic回归分析结果显示:男性、淋巴结转移、包膜外侵犯、未全切除手术、肿瘤最大直径≥2 cm是影响甲状腺乳头状癌复发的独立危险因素(P<0.05),术后应用甲状腺素是甲状腺乳头状癌复发的保护因素(P<0.05)。甲状腺乳头状癌经典型的发病率较高,占甲状腺乳头状癌的87.85%,甲状腺乳头状癌的复发率为8.68%。男性、淋巴结转移、包膜外侵犯、未全切除手术、肿瘤最大直径≥2 cm及特殊病理亚型患者是甲状腺乳头状癌复发的高危人群,需要密切关注病情的进展,按时复查。术后使用甲状腺素可能有助于预防甲状腺乳头状癌的复发。

To analyze the clinicopathological characteristics of each subtype of PTC and the influencing factors of postoperative recurrence of thyroid papillary carcinoma,clinical data and follow-up records of 288 patients with PTC treated in our hospital from May 2010 to December 2015 were collected.To analyze the clinicopathological characteristics of each subtype of PTC,Chi-square test and Logistic regression were used to analyze the risk factors of postoperative recurrence of thyroid papillary carcinoma.Among 288 patients with thyroid papillary carcinoma included in this study,45 cases were solid variant of papillary thyroid carcinoma,accounting for 15.63%.There were 20 cases with tall cell variant,accounting for 6.94%.Diffuse sclerosing variant was found in 25 cases(8.68%).There were 35 cases of follicular variant of papillary thyroid carcinoma,accounting for 12.15%.There were 28 cases of non-intrapsular type and 7 cases of intraperitoneal type.The remaining 253 cases were all classical papillary thyroid carcinoma,accounting for 87.85%.The results of univariate analysis showed that:gender,extrapsular invasion,lymph node metastasis,first operation,taking thyroxine postoperative,maximum tumor diameter,TNM stage was all correlated with the recurrence of thyroid papillary carcinoma(P<0.05).Age and multifocal lesions were not associated with recurrence of papillary thyroid carcinoma(P<0.05).Logistic analysis showed that male,lymph node metastasis,extrapsular invasion,incomplete resection,maximum tumor diameter 2 cm and specific pathological subtype were independent risk factors for recurrence of thyroid papillary carcinoma(P<0.05),and postoperative thyroxine was a protective factor for recurrence of thyroid papillary carcinoma(P<0.05).Thyroid papillary carcinoma typically has a higher incidence,accounting for 87.85%of thyroid papillary carcinoma.The PTC of Men and the patients with lymph node metastasis,extrapsular invasion,incomplete resection,and maximum tumor diameter≥2 cm are high-risk groups for PTC recurrence,so it is necessary to pay close attention to the progress of PTC and timely review after operation.The use of thyroxine postoperatively can prevent recurrence of papillary thyroid cancer.