多灶性甲状腺乳头状癌高容量淋巴结转移的相关因素

Related factors of high-volume lymph node metastasis in multifocal papillary thyroid carcinoma

目的探讨多灶性甲状腺乳头状癌(MPTC)高容量淋巴结转移(HVM)的相关因素。方法回顾性分析2010年1月至2023年3月杭州市第一人民医院多灶性甲状腺微小乳头状癌(MPTMC,瘤体最大径≤10 mm)及MPTC(瘤体最大径>10 mm)患者的临床及病理资料。通过单因素及多因素logistic回归分析HVM的相关因素。结果纳入MPTMC 566例,男72例,女494例,年龄M(Q 1,Q 3)47(39,54)岁;MPTC患者381例,男106例,女275例,年龄47(34,56)岁。MPTMC和MPTC患者HVM发生率分别为4.6%(26/566)和21.5%(82/381),差异有统计学意义(χ^(2)=64.588,P<0.001)。单因素分析结果显示,MPTMC和MPTC患者中,男性发生HVM的比例均高于女性,分别为15.3%(11/72)比3.0%(15/494)(χ^(2)=21.487,P<0.001)、33.2%(35/106)比17.1%(47/275)(χ^(2)=11.492,P=0.001);HVM者的年龄均小于非HVM者,分别为41(33,50)岁比48(39,54)岁(Z=-2.128,P=0.033)、38(29,48)岁比48(36,57)岁(Z=-4.987,P<0.001),HVM者的瘤体最大径均大于非HVM者,分别为7.0(5.0,10.0)mm比6.0(5.0,8.0)mm(Z=-2.558,P=0.011)、17.5(13.0,25.0)mm比15.0(12.0,20.0)mm(Z=-2.871,P=0.004)。多因素logistic回归分析结果显示,瘤体最大径较大(OR=3.027、2.378,95%CI:1.287~7.117和1.404~4.030,P=0.011、0.001)、男性(OR=5.398、1.909,95%CI:2.284~12.758和1.113~3.274,P<0.001、P=0.019)、年龄较小(OR=3.889、3.136,95%CI:1.686~8.969和1.837~5.355,P=0.001、P<0.001)为MPTMC和MPTC患者发生HVM的相关因素。结论MPTC患者发生HVM比例高于MPTMC;瘤体最大径较大、男性和年龄较小为MPTMC和MPTC患者发生HVM的相关因素。

Objective To explore the related factors of high-volume lymph node metastasis(HVM)in multifocality papillary thyroid carcinoma(MPTC).Methods The clinical and pathological data of multifocality papillary thyroid carcinoma(MPTMC,d≤10 mm)and MPTC(d>10 mm)collected from Hangzhou First People′s Hospital from January 2010 to March 2023 were retrospectively analyzed.Univariate and multivariate logistic regression analysis were used to analyze the relevant factors of HVM.Results Among 566 cases of MPTMC and 381 cases of MPTC,there were 72 males and 494 females in MPTMC,106 males and 275 females in MPTC,respectively.The median age of the patients was 47(39,54)and 47(34,56)years,respectively,and the incidence of HVM was 4.6%(26/566)and 21.5%(82/381),respectively(χ^(2)=64.588,P<0.001).Univariate analysis showed that in patients with MPTMC and MPTC,the incidence of HVM in males was higher than that in females[15.3%(11/72)vs 3.0%(15/494)(χ^(2)=21.487,P<0.001)in MPTMC,33.2%(35/106)vs 17.1%(47/275)(χ^(2)=11.492,P=0.001)in MPTC].The age of the HVM group was lower than that of the non-HVM group[41(33,50)vs 48(39,54)years(Z=-2.128,P=0.033)in MPTMC,38(29,48)vs 48(36,57)years(Z=-4.987,P<0.001)in MPTC].The maximum diameter of tumors in the HVM group were higher than those in the non-HVM group[7.0(5.0,10.0)mm vs 6.0(5.0,8.0)mm(Z=-2.558,P=0.011)in MPTMC,17.5(13.0,25.0)mm vs 15.0(12.0,20.0)mm(Z=-2.871,P=0.004)in MPTC].Multivariate logistic regression analysis showed that larger tumor size(OR=3.027,2.378;95%CI:1.287-7.117,1.404-4.030;P=0.011,0.001),male(OR=5.398,1.909;95%CI:2.284-12.758,1.113-3.274;P<0.001,P=0.019),and younger age(OR=3.889,3.136;95%CI:1.686-8.969,1.837-5.355;P=0.001,P<0.001)were all risk factors for the occurrence of HVM in MPTMC and MPTC.Conclusion The proportion of HVM in MPTC patients was higher than that in MPTMC,and larger maximum diameter,male gender and younger age are related factors for HVM in MPTMC and MPTC.