甲状腺乳头状癌颈部中央区淋巴结转移相关因素分析

Risk factors for central neck lymph node metastases of papillary thyroid carcinoma

目的 探索与甲状腺乳头状癌（papillary thyroid carcinoma,PTC）颈部中央区淋巴结转移（central neck lymph node metastases,CLNM）相关的因素,提高术前检出率.方法 回顾性收集2014年1月至2016年7月于西安交通大学第一附属医院行甲状腺全切或腺叶切除并且进行至少一侧中央区淋巴清扫的甲状腺乳头状癌手术患者498例.以PTC病理结果为基础,对患者的基本临床特征,术前甲状腺功能,术前颈部超声表现等进行单因素及多因素比较分析,找出CLNM相关因素.综合相关指标构建方程评估PTC患者发生CLNM的可能性,受试者工作特征曲线（receiver operatingcharacteristic curve,ROC）评价其应用价值.结果 498例PTC患者中284例发生了CLNM.颈部淋巴结超声用于诊断CLNM灵敏度31.3％,特异度88.3％.单因素和多因素分析显示：性别、年龄、超声下甲状腺可疑结节大小及数量等与CLNM相关（P＜0.05）.ROC曲线评价方程在预测PTC发生CLNM时的应用价值,曲线下面积（area under the cmve,AUC）为0.748,P＜0.001,灵敏度为80.8％,特异度为59.8％.结论 除超声提示可疑淋巴结转移外,性别、年龄、超声下甲状腺可疑结节大小及数量等均与CLNM相关.综合了多项指标构建的方程预测PTC发生CLNM的灵敏度较单纯颈部淋巴结超声明显提高,特异度下降.

Objective To investigate the impact factors for central neck lymph node metastases （CLNM） of papillary thyroid carcinoma（PTC）.Methods A total of 498 patients with PTC who underwent total or hemi-thyroidectomy plus central neck lymph node dissection between January 2014 and July 2016 were included.Univariate and multivariate analyses were performed to identify clinicopathological characteristics,thyroid function parameters and US findings that associated with CLNM of PTC.A nomogram was developed to predict the probability of CLNM.The receiver operating characteristic curve （ROC） was used to estimate the efficiency of the nomogram.Results Among 498 patients,284 patients were affected by CNLM.The sensitivity and specificity of US in predicting PTC metastasis in the central neck were 31.3% and 88.3%,respectively.Univariate and multivariate analyses showed that gender,age,number and size of suspicious malignant nodules in thyroid,and suspicious lymph node metastasis detected by ultrasonography were independently correlated with CLNM.The ROC showed that the AUC was 0.748,with sensitivity of 80.8%,and specificity of 59.8%.Conclusions Gender,age,number and size of suspicious malignant nodules in thyroid,suspicious lymph node metastasis were predictive factors for CLNM in patients with PTC.The nomogram developed based on related factors with CLNM is more sensitive than sonographic central neck lymph node features in predicting the probability of CLNM.