甲状腺乳头状癌颈淋巴结转移特点及危险因素分析

An analysis of features and risk factors for neck lymph node metastasis in papillary thyroid carcinoma

目的:探讨甲状腺乳头状癌颈淋巴结转移特点及相关危险因素在颈部不同区域淋巴结转移中的意义。方法:回顾性分析北京世纪坛医院2010年1月至2014年12月术后病理证实为甲状腺癌的404例患者的临床资料,就年龄、性别、术前TSH水平、肿瘤最大径、多灶病变、被膜侵犯、合并桥本甲状腺炎、合并结节性甲状腺肿等因素与颈部不同区域淋巴结转移之间的关系进行分析。结果:甲状腺癌发生淋巴结转移时,多数转移至中央区,其次为颈侧区,颈侧区淋巴结转移中Ⅲ区和Ⅳ区转移率相当,且明显高于Ⅱ区。单因素分析结果显示,性别、肿瘤最大径、多灶病变、被膜侵犯、合并结节性甲状腺肿与中央区、颈侧区淋巴结转移均有关(P<0.05),而年龄和中央区淋巴结转移有相关性(P<0.05),合并桥本甲状腺炎与颈侧区淋巴结转移有相关性(P<0.05);多因素Logistic回归分析结果显示,男性患者、年龄<45岁、肿瘤最大径>1cm、多灶病变是中央区淋巴结转移的独立危险因素(P<0.05),而多灶病变、被膜侵犯、合并桥本甲状腺炎是颈侧区淋巴结转移的独立危险因素(P<0.05)。结论:甲状腺乳头状癌中年龄<45岁的男性患者、肿瘤最大径>1cm、多灶病变可增加中央区淋巴结转移的风险。而表现为多灶病变、被膜侵犯、合并桥本甲状腺炎、可疑跳跃性转移及中央区淋巴结转移阳性的患者,颈侧区淋巴结转移风险性增加。

Objective： To investigate features and risk factors for regional neck lymph node metastasis in papillary thyroid carcinoma. Methods： The data of 404 patients with PTC who were treated in Beijing Shijitan Hospital from January 2010 to December 2014 were retrospectively analyzed. The relationship among the neck lymph node metastasis of different area and patient ＇s gender,age,preoperative TSH level,tumor max diameter,multifocality,capsular invasion,PTC with Hashimotos Thyroiditis,PTC with nodular goiter were analyzed. Results： When PTC associated with neck lymph node metastasis,most of them metastasis to central lymph node metastasis,followed by lateral lymph node metastasis. The transfer rate of region Ⅲ and Ⅳ was equivalent and higher than region Ⅱ. The univariate analyses of neck lymph node metastasis results showed that gender,tumor max diameter,multifocality,capsular invasion,PTC with nodular goiter were statistically significantly related to both central lymph node metastasis and lateral lymph node metastasis（ P〈0. 05）. While age was statistically significantly related to central lymph node metastasis（ P〈0. 05）. For lateral lymph node metastases,the PTC with hashimotos thyroiditis were statistically significant（ P〈0. 05）. The multivariate Logistic regression analysis showed that male patient＇s age 45 years old,tumor max diameter 1cm and multifocality were risk factors for central lymph node metastasis（ P〈0. 05）. For lateral lymph node metastasis,the multifocality,capsular invasion and associated with Hashimotos Thyroiditis were risk factors（ P〈0. 05）. Conclusion： The male patient＇s age 45 years old,tumor max diameter 1cm and multifocality might increase the risk of central lymph node metastasis. When patients with multifocality,capsular invasion,associated with Hashimotos Thyroiditis,suspicious skip metastasis or with central lymph node metastasis,we should pay attention to the risk of lateral lymph node metastases.