甲状腺微小乳头状癌中央区淋巴结转移危险因素分析

Analysis of risk factors for central lymph node metastasis in patients with papillary thyroid microcarcinoma

目的探讨甲状腺微小乳头状癌(PTMC)患者中央区淋巴结转移的危险因素。方法回顾性分析2014-2016年新疆医科大学附属中医医院收住的252例甲状腺微小乳头状癌患者临床病理资料,应用χ~2检验和多因素Logistic回归模型分析中央区淋巴结转移的危险因素。结果 252例PTMC患者中男女性别比1∶3.9,平均年龄(42.5±2.5)岁,中央区淋巴结转移率为31%。单因素分析显示肿瘤最大直径、侵犯包膜、病灶存在砂粒体均与中央区淋巴结转移相关。发病年龄、性别、有无桥本甲状腺炎、病灶中心纤维化、以乳头结构为主均与中央区淋巴结转移无关。多因素Logistic回归分析显示肿瘤直径>5mm、侵犯包膜为中央区淋巴结转移的独立危险因素。结论肿瘤直径>5 mm、有包膜侵犯的PTMC患者较易发生中央区淋巴结转移,建议冷冻诊断术中行预防性中央区淋巴结清扫。

Objective To explore risk factors of central lymph node metastasis in patients with papillary thyroid microcarcinoma（ PT- MC）. Methods Clinical pathological data of 252 cases of PTMC were retrospectively analyzed in Mfiliated Traditional Chinese Medi- cine Hospital,Xinjiang Medical University from 2014 to 2016. The risk factors of central lymph node metastasis in PTMC were analyzed byx2 and multi-factor Logistic regression model. Results The ratio of male to female was 1 ： 3.9 for PTMC patients with average age of （42. 5 ± 2. 5 ）years. The metastasis rate of central lymph node was 31%. Single factor analysis showed that the incidence of central lymph node metastasis was correlated with tumor diameter, capsular invasion, gravel body in the lesions, but not with age, gender, Hashi- moto＇ s thyroiditis, center fibrosis of the lesion, and papillary structure. Muhi-factor Logistic regression model revealed that the tumor size 〉 5 mm and capsular invasion were independent risk factors for central lymph node metastasis. Conclusion The tumor diameter 〉 5 mm and capsular invasion are prone to central lymph node metastasis in PTMC patients. It is necessary to perform central lymph node dissection during operation by frozen diagnosis preventively.