单发甲状腺微小乳头状癌对侧中央区淋巴结转移的危险因素

The Risk Factors of Contralateral Central Lymph Node Metastasis in Solitary Thyroid Papillary Micro-carcinoma

目的探讨单发甲状腺微小乳头状癌(papillary thyroid micro-carcinoma,PTMC)对侧中央区淋巴结转移的可能危险因素。方法回顾性分析2012年4月至2015年5月我科收治的318例病理确诊为单发PTMC并行"甲状腺全切+双侧中央区淋巴结清扫术"患者的临床病理资料,对侧中央区淋巴结转移的危险因素采用χ2检验单因素分析及logistic回归多因素分析。结果单发PTMC中同侧和对侧中央区淋巴结转移率分别为40.57%(129/318)、9.75%(31/318)。单因素分析结果显示对侧中央区淋巴结转移与癌灶位于甲状腺下份、甲状腺被膜浸润、同侧中央区淋巴结转移及合并结节性甲状腺肿相关(P<0.05),多因素分析结果显示癌灶位于甲状腺下份及同侧中央区淋巴结转移是对侧中央区淋巴结转移的独立危险因素(P<0.05)。结论单发PTMC对侧中央区淋巴结转移率比较低,不应该常规行对侧中央区淋巴结清扫;癌灶位于甲状腺下份或同侧中央区淋巴结有转移者,可考虑行双侧中央区淋巴结清扫。

Objective To explore the possible risk factors of contralateral central lymph node metastasis（CLNM）in solitary thyroid papillary micro-carcinoma（PTMC）.Methods Clinicopathologic data of 318 patients with confirmed solitary PTMC by final histological who underwent bilateral centeral lymph node dissection（CLND）from April 2012 to May 2015 in our hospital were retrospectively reviewed.Univariateχ2 test and multivariate logistic regression analysis were used to determine the risk factors of contralateral CLNM in solitary PTMC.Results The incidence of ipsilateral CLNM and contralateral CLNM in solitary PTMC patients were 40.57%（129/318）,9.75%（31/318）,respectively.Univariate analyses revealed that contralateral CLNM had a correlation with tumor located in lower pole,capsular invasionand underlying ipsilateral CLNM（P〈0.05）,and had a correlation with underlying nodular goiter（P〈0.05）.Multivariate logistic regression analysis showed that tumor located in lower pole and ipsilateral CLNM were independent risk factors for contralateral CLNM（P〈0.05）.Conclusions Solitary PTMC patients had a lowtendency to contralateral CLNM,it shouldn＇t undergo contralateral CLND commonly,if the tumor located in lower pole or combine withipsilateral CLNM,it should be consider to undergo bilateral CLND.