甲状腺微小乳头状癌颈淋巴结转移的影响因素分析

Analysis of the cervical lymph node metastasis in papillary thyroid microcarcinoma

目的:探讨甲状腺微小乳头状癌颈淋巴结转移的相关因素,为颈淋巴结清扫的范围提供一定的依据。方法:收集甲状腺外科首次手术治疗并确诊为甲状腺微小乳头状癌病人的石蜡组织及临床资料,并对病人的病理、临床特征进行回顾性分析。分析不同年龄、性别、肿瘤直径、原发病灶数目、肿瘤组织是否侵犯甲状腺包膜、是否合并桥本氏甲状腺炎、肿瘤组织缺氧诱导因子1α、血管内皮生长因子的表达与颈部淋巴结淋巴结转移的相关性。结果:325例病人中112例(34.5%)伴颈淋巴结转移,109例(33.5%)伴中央区淋巴结转移,104例(32.0%)伴侧颈淋巴结转移。logistic回归分析显示,男性、年龄<45岁、肿瘤直径>0.5 cm、伴甲状腺包膜浸润、合并桥本氏甲状腺炎和肿瘤组织缺氧诱导因子-1α、血管内皮生长因子的阳性表达均是甲状腺微小乳头状癌颈淋巴结转移的危险因素(P<0.05)。结论:甲状腺微小乳头状癌发生颈部淋巴结转移率高,以上独立危险因素可以为正确处理病情提供重要依据。

Objective：To explore the related factors of the cervical lymph node metastasis in papillary thyroid microcarcinoma,and provide a theoretical basis in deciding the range of neck lymph node dissection. Methods：The clinical data of the papillary thyroid microcarcinoma patients treated with operation were collected, and the pathological and clinical characteristics were retrospectively analyzed. The correlations between age,gender,tumor size,number of lesions,capsular invasion and hashimoto＆#39;s thyroiditis,HIF-1αand VEGF,and cervical lymph node metastasis were analyzed using logistic regression. Results：Among 325 patients, the cervical lymph node metastasis in 112 cases（34. 5%）,central area lymph node metastasis in 109 cases（33. 5%） and lateral lymph node metastasis in 104 cases（32. 0%） were found. The male,age less than 45 years old,tumor size more than 0. 5 cm,capsular invasion and hashimoto＇s thyroiditis,positive HIF-1αand VEGF were the risk factors of the cervical lymph node metastasis in papillary thyroid microcarcinoma（ P〈 0. 05）. Conclusions：The lymph node metastasis rate of papillary thyroid microcarcinoma is high. The independent risk factors can provide an important basis in the correct treatment of the disease.