甲状腺微小乳头状癌的高细胞亚型与经典型的临床病理特征

Clinical pathological characteristics between the tall cell variant and conventional papillary thyroid microcarcinoma

目的探讨甲状腺微小乳头状癌(PTMC)的高细胞亚型和经典型的临床病理特征差异及颈部淋巴结转移的危险因素。方法选取2018年10月-2020年12月于中国人民解放军联勤保障部队第901医院收治的85例PTMC患者的临床病理资料,对病理切片行伊红-苏木精染色。比较经典型和高细胞亚型的形态学特征和临床病理特征,并分析其中78例行颈部淋巴结清扫的患者颈部淋巴结转移的危险因素。结果与经典型相比,高细胞亚型形态学特征中的肿瘤细胞的高/宽度比>2的比例较高,差异有统计学意义(x^(2)=32.929,P<0.05)。临床病理特征中高细胞亚型瘤体直径>5 mm、包膜侵犯和颈部淋巴结转移率均高于经典型,差异有统计学意义(x^(2)=5.749、4.653、5.313,P均<0.05)。颈部淋巴结转移单因素分析显示,年龄、肿瘤直径、肿瘤多灶性和包膜侵犯是其淋巴结转移的危险因素(x^(2)=5.453、4.953、9.455、13.043,P均<0.05)。多因素分析显示,高细胞亚型、肿瘤多灶性和包膜侵犯是影响颈部淋巴结转移的独立危险因素(OR=5.081、4.510、4.360,P均<0.05)。结论PTMC的高细胞亚型侵袭性强,易发生颈部淋巴结转移。手术切除并行预防性中央区淋巴结清扫是较好的治疗方案。

Objective To investigate the distinct clinicopathological characteristics between the tall cell variant and conventional papillary thyroid microcarcinoma(PTMC)and analyze the independent risk factors for cervical lymph node metastasis.Methods The clinicopathological data of 85 PTMC patients treated in the Joint Logistics Force No.901 Hospital of PLA from October 2018 to December 2020 were analyzed retrospectively.Chi-square test was used to compare the distinct morphological features and clinicopathological characteristics between the tall cell variant and CPTMC.Single factor analysis and multivariate Logistic regression analysis were performed for the 78 patients who underwent cervical lymph node dissection for single and multi-factors for cervical lymph node metastasis.Results The height/width of tumor cells was statistically significant compared to>2 among all the morphological features(x^(2)=32.929,P<0.05).The rate of tumor diameter(>5 mm),capsular invasion and cervical lymph node metastasis in tall cell variant were higher than those in CPTMC,which was significant different(x^(2)=5.749,4.653,5.313,all P<0.05).Single-factor analysis of cervical lymph node metastasis showed that age,tumor diameter,multifocality of tumor and envelope invasion were the risk factors for lymph node metastasis(x^(2)=5.453,4.953,9.455,13.043,all P<0.05).Multivariate analysis showed that the tall cell variant,multifocality and capsule invasion were independent risk factors for cervical lymph node metastasis(OR=5.081,4.510,4.360,all P<0.05).Conclusion As tall cell variant is highly aggressive and prone to cervical lymph node metastasis,thyroid lobectomy and prophylactic central neck dissection should be a better choice for this variant.