甲状腺全切术后接受^131 I治疗的微小乳头状癌淋巴结转移临床特点

Clinical features of lymph node metastasis in papillary thyroid microcarcinoma with ^131 I treatment

目的探讨甲状腺微小乳头状癌（ papillary thyroid microcarcinoma,PTMC）淋巴结转移临床特点。方法回顾性分析198例甲状腺全切并至少接受1次^131 I治疗的PTMC患者,按照是否发生淋巴结转移分组,分析淋巴结转移的临床特点及中央区、侧区淋巴结转移的独立危险因素。结果 PTMC患者伴颈部淋巴结转移的临床特点：年龄多为〈45岁的年轻患者（63.4%对44.9%,P=0.012）；更容易侵出双侧腺叶及侵出被膜（56.7%对42.0%,P=0.043；63.6%对36.4%,P=0.034）；其平均肿瘤直径大于未发生淋巴结转移组[（0.71±0.25对0.64±0.24） cm,P=0.047]；淋巴结转移组患者术前甲状腺球蛋白抗体（thyroglobulin antibody,TgAb）水平高于非淋巴结转移组[（65.27±139.179对36.36±95.647） IU/L,P=0.03）；经过^131 I治疗后,随诊1~6年,其治愈率与未发生颈部淋巴结转移组患者未见明显统计学差异,但颈部淋巴结转移组患者131I治疗的次数多于对照组[（1.77±0.77对1.49±0.74）次, P=0.006]。单因素分析显示,患者年龄、肿瘤大小、累及腺叶及有无被膜侵犯与中央区淋巴结转移密切相关；桥本甲状腺炎与侧区淋巴结转移密切相关。多因素分析显示,患者年龄、肿瘤大小、累及双侧腺叶及被膜侵犯是中央区淋巴结转移的独立危险因素。结论 PTMC患者首次手术应充分评估淋巴结转移的高危因素,实施个体化治疗。

Objective To analyze the clinical features of lymph node metastasis in papillary thyroid microcarcinoma（ PTMC） . Methods 198 patients with PTMC who have underwent total thyroidectomy and at least one ^131 I treatment were divided into two groups according to the occurrence of lymph node metastasis. The clinical features of lymph node metastasis in PTMC were retrospective analyzed, and independent risk factors of the central and lateral lymph node metastasis in PTMC patients were further analyzed. Results Clinical features of PTMC patients with cervical lymph node metastasis：（1）Most of them were〈45 years old（63. 4% vs 44. 9%,P=0. 012）;（2）More patients with cancer in bilateral lobes and extrathyroidal extension in lymph node metastasis groups （ 56. 7% vs 42. 0%, P=0. 043;63. 6% vs 36. 4%, P=0. 034）; （3） The average tumor size of the patients of lymph node metastasiswaslargerthanthatofthepatientswithoutlymphnodemetastasis[（0.71±0.25vs0.64±0.24）cm,P=0. 047];（4）Preoperative thyroglobulin antibody（TgAb） level of PTMC patients with cervical lymph node metastasis was higher than the control group[（65. 27 ± 139. 179 vs 36. 36 ± 95. 647） IU/L, P=0. 03]; （5） After the 131I treatments and by 1-6 years of follow-up, it is found no statistically significant difference in cure rate between patients with cervical lymph node metastasis after total thyroidectomy and its control group. But the frequency of 131 I treatment required in patients with cervical lymph node metastasis was higher than that of the control group（1. 77 ± 0. 77 vs 1. 49 ±0.74, P=0.006）. Univariate analysis revealed that central lymph node metastasis was correlated with age, tumor size and other factors. There were more patients with cancer in bilateral lobes and extrathyroidal extension in lymph node metastasis group. And lateral lymph node metastasis was correlated with Hashimoto′s thyroiditis. Multivariate analysis showed that age, tumor size, involvement of bilateral glandular lobes and extrathyroidal extension were independent risk factors for central lymph node metastasis. Conclusion The risk factors of lymph node metastasis should be fully evaluated to carry out individualized treatment for the first operation of PTMC patients.