甲状腺乳头状癌中央区淋巴结转移危险因素研究(附3273例回顾性分析)

Risk factors of central lymph node metastasis of papillary thyroid carcinoma:A single-center retrospective analysis of 3273 cases

目的探讨甲状腺乳头状癌(PTC)病人临床病理学特征及中央区淋巴结转移(CLNM)的危险因素。方法回顾性分析2007年1月至2016年6月,昆明医科大学第一附属医院甲状腺疾病诊治中心具有完整病例资料的3273例PTC病人临床病理学特征,应用χ~2检验和多因素Logistic回归模型分析CLNM的危险因素。结果 PTC的CLNM发生率为40.6%(1331/3273),清扫中央区淋巴结中位数7.0(4.0,12.0)枚,平均转移(3.70±3.84)枚。单因素分析显示性别、年龄、肿瘤直径、腺外浸润、多灶性、合并结节性甲状腺肿、体征、是否观察均与CLNM相关(P<0.05)。在肿瘤仅占据甲状腺单个区域病人中,位于下份(41.6%)是CLNM的危险因素(P<0.001),而与肿瘤数量无关(P=0.68)。多灶癌CLNM发生率双侧多区域(51.3%)>单侧多区域(47.2%)>单个区域(36.7%)(P=0.003)。多因素Logistic回归分析显示性别、年龄、肿瘤直径、腺外浸润和观察是CLNM的独立危险因素。结论临床病理特征对CLNM具有一定的预测价值,可为PTC病人治疗方案制定提供一定的参考。

Objective To investigate the clinicopathological features of papillary thyroid carcinoma （PTC）and the risk factors of central lymph node metastasis （CLNM）. Methods The clinicopathological features in PTC patients with complete case data admitted from January 2007 to June 2016 in the First Affiliated Hospital of Kunming Medical University were analyzed retrospectively. The risk factors of CLNM were analyzed by χ2 test and multivariate logistic regression model.Results The CLNM rate of PTC was 40.6% （1331/3273）. On average, 7.0 （4.0,12.0）central lymph nodes were dissected, and 3.70（±3.84）lymph nodes were proved to be metastatic. Univariate analysis showed that gender, age, tumor diameter, extrathyroid extension, multifocality, concurrent nodular goiter, initial symptoms and observation or not were related to CLNM（P〈0.05）. Tumors located in the lower part of the thyroid （41.6%）was the risk factor for CLNM （P〈0.001）, while multifocality was unrelated （P=0.68）. The metastasis rate of bilateral multiple regions（51.3%）〉 unilateral multiple regions （47.2%）〉 single region （36.7%）（P=0.003）. Multivariate logistic regression analysis showed that gender, age, tumor diameter, extrathyroidal extension and observation were independent risk factors of CLNM. Conclusion Clinical and pathological features have certain predictive value for CLNM, and can provide a reference for the treatment program of PTC patients.