临床cN0期甲状腺微小乳头状癌中央区淋巴结转移危险因素分析及手术方式探讨

Central lymph node metastasis of cNO papillary thyroid microcarcinoma：risk factors and operation methods

目的 探讨甲状腺微小乳头状癌（papillary thyroid mierocarcinoma，PTMC）患者临床病理参数与中央区淋巴结转移的相关性。方法 收集天津医科大学肿瘤医院甲状腺颈部肿瘤科2013年1月至2013年6月首治的400例cN0期PTMC患者的临床病理资料。结果 单因素分析显示：PTMC中央区淋巴结转移率为28．0％，〈45岁者中央区淋巴结转移率为32．5％，男性患者中央区淋巴结转移率为42．6％，腺外侵犯型PTMC中央区淋巴结转移率为44．1％，肿瘤直径〉5mm中央区淋巴结转移率为33．3％，多灶患者中央区淋巴结转移率为37．4％，从而得出患者性别、年龄、腺外侵犯、肿瘤直径、原发病灶数均与中央区淋巴结转移相关。多因素Logistic回归分析显示：当患者为男性，年龄〈45岁，肿瘤有腺外侵犯，多病灶者，淋巴结转移发生率明显增加（P〈0．05）。结论 对于cN0期PTMC，可综合考虑患者性别、年龄、原发病灶数及肿瘤腺外侵犯等因素，细化中央区淋巴结清扫术处理原则，行原发灶手术的同时，应同期行预防性中央区淋巴结清扫术。

Objective To study the relationship between clinicopathological features and central lymph nodes metastasis in patients with papillary thyroid microcarcinoma（PTMC）. Methods From Jan. 2013 to Jun. 2013, 400 cases with PTMC in cN0 stage undergoing thyroidectomy and central neck dissection were collected. Results Univariate analysis showed that the rate of central lymph node metastasis in PTMC was 28.0% , nevertheless,the rate of central lymph node metastasis was 32. 5% , 42. 6% , 44. 1%, 33.3% , and 37.4% respectively in patients aging below 45 years old, in male patients, in patients with extrathyroidal extension, in patients with tumor diameter larger than 5 mm and in patients with muhifocality. Gender, age, extrathyroidal extension, tumor diameter, muhifocality of patients had correlation with central lymph node metastasis. Multivariate binary logistic regression analysis revealed that the rate of lymph node metastasis significantly increased in cases of male, ageing below 45 years old, with extrathyroidal extension and muhifocality（ P 〈 0. 05 ）. Conclusions The treatment for central lymph node metastasis of PTMC should be different considering elements including gender, age, multifoeality of the tumor, and extrathyroidal extension. Prophylactic central lymphadenectomy should be performed when the primary lesion was resected.