PTC组织学亚型与颈淋巴结转移及近期预后的关系

Pathological subtypes of papillary thyroid carcinoma and its relationship with cervical lymph node metastasis and prognosis

目的探讨甲状腺乳头状癌（PTC）的病理组织学亚型与颈淋巴结转移及近期预后的关系，为术中颈淋巴结清扫提供指导。方法回顾性分析2008年6月—2011年11月期间220例PTC患者的病理及临床随访资料，分析各组织学亚型与颈淋巴结转移及患者近期存活情况的关系。结果PTC各组织学亚型中，包膜外型（78．95％）、滤泡型（71．43％）、弥漫硬化型（58．82％）的转移率均高于柱状细胞型（41．46％）、高细胞型（29．41％）、微小型（26．67％），差异均具有统计学意义（X2=3．56～8．11，P〈0．05或P〈0．01）。PTC患者术后3年病死率为3．18％，包膜外型（10．53％）、弥漫硬化型（5．88％）、滤泡型（4．76％）、柱状细胞型（3．33％）患者的病死率较高，高于微小型、高细胞型和其他类型，差异均具有统计学意义（X2=3．26～5．02，P〈0．05）。结论甲状腺乳头状癌病理组织学亚型与颈淋巴结转移及预后具有紧密的关系，在各组织学亚型中，以包膜外型、滤泡型、弥漫硬化型的转移率较高和预后较差，而包膜内型、微小型、高细胞型的转移率较低，预后较好。参照组织学亚型对术中进行颈淋巴结清扫与否可能具有一定的指导意义。

Objective To explore the pathological subtypes of papillary thyroid carcinoma（PTC） and its relationship with cervical lymph node metastasis and prognosis, and guide for cervical lymph node dissection in operations. Methods Pathological and clinical follow-up data of 220 patients with PTC from June 2008 to November 2011 were retrospectively analyzed,and the relationship between cervical lymph node metastasis and prognosis with pathological subtypes of PTC were analyzed. Results In various subtypes of PTC, transfer rate of exterior envelope subtype（ 78.95% ）, follicular sub- type（71.43% ） and diffuse sclerosis subtype（58.82% ） were higher than that of columnar cell subtype（41.46% ） ,high cell subtype（29.41% ） and micro subtype （26.67%）, and there were statistical difference among the indicators above （ X2 = 3.56 to 8.11 ,P 〈 0.05 or P 〈 0.01 ）. 3-year-postoperative mortality of PTC was 3.18%. The mortality of exterior envelope subtype （ 10.53 % ）, diffuse sclerosis subtype （ 5.88 % ）, follicular subtype （ 4.76% ） and columnar cell subtype （3.33 % ） were higher than those of micro subtype, high cell subtype and other subtypes, and there were statistical differ- ence among above indicators （X2 = 3.26 to 5.02, P 〈 0.05 ）. Conclusion It has closely relationship between cervical lymph node metastasis and prognosis with pathological subtypes of PTC. In various subtypes of PTC, exterior envelope sub- type, follicular subtype and diffuse sclerosis subtype has higher metastasis rate and poor prognosis, yet interior envelope subtype, micro subtype and high cell subtype has lower metastasis rate and better prognosis, so it has some guiding signifi- cance for cervical lymph node dissection selection of PTC surgery according to its pathological subtypes.