甲状腺乳头状微小癌侧颈淋巴结转移分析

Clinical Analysis of Lateral Cervical Lymph Node Metastases from Papillary Thyroid Microcarcinoma

目的:分析伴侧颈淋巴结(Ⅱ～Ⅴ区)转移的甲状腺乳头状微小癌(PTMC)的临床生物学特性及预后,探讨侧颈淋巴结转移的危险因素及合适的治疗方案。方法:回顾性分析2001年8月至2006年8月天津医科大学附属肿瘤医院收治的具有完整病例资料的PTMC 286例,其中病理证实存在Ⅱ-Ⅴ区淋巴结转移者35例,并通过SPSS 17.0软件进行统计分析。结果:本组病例男女比例为1:2.9,平均年龄45.7岁。18例(51.4%)患者以侧颈部肿物就诊。14例(40.0%)患者伴发桥本氏甲状腺炎。10例(28.6%)原发灶侵出甲状腺腺叶。多灶性(40.0%)及癌灶位于甲状腺上极的比例(54.3%)均高于同期不伴侧颈淋巴结转移的PTMC(P<0.05)。1例患者就诊时发现肺转移。侧颈淋巴结转移Ⅳ区最常见,其次为Ⅲ区、Ⅱ区,Ⅴ区最少见。11例患者Ⅵ区未见转移而侧颈出现淋巴结转移。随访发现1例患侧颈部淋巴结复发,2例对侧颈部出现淋巴结转移,1例肺转移,1例患侧颈部淋巴结复发且对侧甲状腺发现新发癌灶。结论:此类患者多数以颈部肿物就诊,因甲状腺原发灶隐匿,容易误诊。与同期不伴侧颈淋巴结转移PTMC者性别、年龄、伴发桥本氏甲状腺炎及腺外侵犯率差异不明显。多灶性及癌灶位于甲状腺上极可能是PTMC出现侧颈淋巴结转移的危险因素。此类患者复发率高,应采取积极的治疗方案,并应加强随访力度。

Objective： To analyze the clinical biological characteristics and prognosis of papillary thyroid microcarcinoma and to investigate the treatment and risk factors of lateral cervical lymph node metastases from papillary thyroid microearcinoma. Methods： A total of 286 patients with papillary thyroid microcarcinoma, who were treated in Tianjin Medical University Cancer Institute and Hospital between August 2001 and August 2006, were retrospectively studied. Cases, which had lateral cervical lymph node metastases as confirmed by pathology, were chosen. Clinical data was then evaluated using SPSS 17.0 statistical software package. Results： The ratio of male to female was 1：2.9, and the mean age was 45.7 years. Of the 35 patients, 18 （ 51.4% ） patients came to the hospital because of lateral cervical mass. Fourteen （ 40.0% ） patients also had Hashimoto＇s thyroiditis, whereas 10 （ 28.6% ） patients were extrathyroidal or had invasion into the surrounding tissue or organs. Fourteen （ 40.0% ） patients had multifocality, and carcinomas occupied the upper re- gion of the thyroid in 55.6% patients, which were both higher than the rate in papillary thyroid microcarcinoma without lateral cervical lymph node metastases （ P 〈 0.05 ）. Moreover, one patient also had distant metastasis. Lateral cervical lymph node metastases in com- partment IV were most common, while they were rare in compartment V. There were 11 patients whose lymph nodes in compartment VI appeared negative, but their lateral cervical compartments were positive. Follow-up data were as follows： one patient relapsed into primary lateral cervical compartments; two patients had new lymph node metastases in contralateral neck; one patient had distant metas- tases; one patient relapsed in primary lateral cervical compartments and found new carcinoma in remnant thyroid. Conclusion： In pa- tients with lateral cervical mass, the diagnosis of lymph node metastasis from papillary thyroid microcarcinoma should be always con- sidered. The ratio of male to female, the mean age, and the rate of coexisting Hashimoto＇s thyroiditis and extrathyroidal invasion did not differ significantly from papillary thyroid microcarcinoma without lateral cervical lymph node metastases. Multifocality and carcinomas occupying the upper region of the thyroid may be the risk factors of lateral cervical lymph node metastases from papillary thyroid microcarcinoma. Prognosis is relatively poor, and the disease can recur easily. Thus, positive treatment should be chosen, and long-term follow-up is necessary.