甲状腺乳头状癌颈侧区淋巴结跳跃转移危险因素分析

Predictive factors of skip metastasis to lateral with leaping central lymph node in papillary thyroid carcinoma

目的:探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)淋巴结跳跃转移(中央区无淋巴结转移,颈侧区有淋巴结转移)的规律及危险因素。方法:回顾性分析2013年1月至2016年12月重庆医科大学附属第一医院521例行甲状腺全切+中央区及颈侧区淋巴结清扫的PTC患者的临床病理资料,分析跳跃转移的危险因素。结果:本研究PTC跳跃转移率为8.3%(43/521),肿瘤位于甲状腺上极(OR=3.401,95%CI:1.770~6.536;P=0.001),年龄>45岁(OR=2.856,95%CI:1.488~5.482;P=0.002),单侧癌(OR=3.424,95%CI:1.182~9.920;P=0.023)是PTC出现颈侧区淋巴结跳跃转移的独立危险因素。本研究比较c N1b的PTC患者和肿瘤位于甲状腺上极的c N0 PTC患者跳跃转移情况,发现肿瘤位于上极c N0的PTC患者出现潜在跳跃转移的可能性高于c N1b患者(P=0.022)。结论:PTC颈侧区淋巴结跳跃转移并不少见,术前、术中针对颈侧区淋巴结转移状态的评估很重要,尤其是肿瘤位于上极,年龄>45岁的单侧PTC患者,必要时需行患侧颈侧区淋巴结清扫。

Objective：To retrospectively analyze the regularity and risk factors of skip metastasis（central lymph node negative and lateral lymph node positive） in papillary thyroid carcinoma（PTC）.Methods：A total of 521 PTC patients underwent total thyroidectomy and central plus lateral lymph node dissection at The First Affiliated Hospital of Chongqing Medical University from January 2013 to December 2016.Clinicopathological characteristics of the patients were collected and analyzed.Results：Skip metastasis rate of PTC was8.3%（43/521）.Tumors in the upper lobe（OR=3.401,95% CI：1.770-6.536;P=0.001） and in the lateral part（OR=3.424,95% CI：1.182-9.920;P=0.023） of the thyroid,as well as age above 45（OR=2.856,95% CI：1.488-5.482;P=0.002）,were independent risk factors for skip metastases for this disease.Clinically node-negative（c N0） PTC patients with tumors in the upper lobe had higher possibility of skip metastases than those with clinically involved lateral neck nodes（c N1 b）（P=0.022）.Conclusion：Skip metastasis of PTC is not uncommon.Thus,preoperative clinical assessment and imaging examination for lateral lymph node is necessary,especially for PTC patients who are above 45 years old and with tumors in the upper lobe and/or unilateral area of thyroid.The lateral lymph node dissection should be performed when necessary.