cNO期甲状腺乳头状癌中央区淋巴结转移影响因素分析

Risk factors for central lymph node metastasis in cNO papillary thyroid carcinoma

目的总结PTC预防性中央区淋巴结清扫结果并分析中央区淋巴结（CLN）转移影响因素。方法回顾性分析453例oN0PTC患者临床资料，采用矿检验和Logistic回归模型进行统计分析。结果CLN转移率为45．3％（205／453）。单因素分析显示：CLN转移与性别、年龄、包膜侵犯、肿瘤最大径、累及双侧或峡部、多灶性及结节性甲状腺肿（简称“结甲”）显著相关（P〈0．05）。多因素分析显示：肿瘤最大径〉2cm（OR=3．935），年龄〈45岁（OR=1．954）及男性（OR=1．741）是CLN转移独立危险因素，而结甲（OR=0．422）是CLN转移保护因素。暂时性和永久性低钙血症发生率分别为30．9％，0．7％，暂时性和永久性RLN损伤发生率分别为2．2％，0．2％。结论cN0 PTC有较高的CLN转移率，肿瘤大小〉2em，〈45岁和男性患者是CLN转移高危因素。对oN0 PTC患者施行预防性中央区淋巴结清扫安全必要。

Objective To summarize the results of prophylactic central neck dissection （pCND） for pap- illary thyroid carcinoma （PTC） and to analyze related factors for central lymph nodes metastasis （CLNM）. Meth- otis 453 patients with cN0 PTC were analyzed retrospectively. x2 test and logistic regression analysis were ap- plied to statistical analysis. Results CLNM rate was 45.3% （205/453）. Univariate analysis showed that CLNM was closely related with sex, age, capsular invasion, tumor size, diseased lobes, multifocality and nodular goiter （P〈0.05）. Multivariate analysis showed that tumor size greater than 2 cm （OR=3.935）, age less than 45 years （OR= 1.954） and male sex （OR=1.741） were independent risk factors for CLNM, while nodular goiter was protective factor for CLNM （0R=0.422）. Rate of temporary and permanent hypocalcemia was 30.9% （140/453） and 0.7 %（3/ 453）respectively, while rate of temporary and permanent recurrent laryngeal nerve injury was 2.0% （9/453） and 0.2% （1/453） respectively. Conclusions CLNM is relatively common in cN0 PTC patients. Tumor size greater than 2 era, age less than 45 years and male sex are high-risk factors of CLNM. It＇s safe and necessary to perform pCND for patients with cN0 PTC.