甲状腺微小乳头状癌中央区淋巴结转移相关因素分析

Related factors of central regional lymph node metastasis in thyroid papillary microcarcinoma

目的探讨甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）患者中央区淋巴结转移（central lymph node metastasis，CLNM）相关因素。方法回顾性分析550例临床淋巴结转移阴性（clini-cal lymph node negative，cN0）的PTMC患者的临床病理特征，应用χ2检验和多因素Logistic回归分析CLNM的相关因素。应用ROC曲线对肿瘤直径与CLNM规律进行分析。结果CLNM率为35.6%。单因素分析年龄〈45岁（χ2=13.983，P〈0.001）、肿瘤直径≥7 mm（χ2=14.263，P〈0.001）、包膜受侵（χ2=7.316，P=0.006）、多灶（χ2=14.321，P〈0.001）和双侧癌（χ2=9.265，P=0.002）更容易发生CLNM（P〈0.05），多因素Logistic回归分析显示年龄〈45岁、肿瘤直径≥7 mm、包膜受侵及多灶是PTMC患者CLNM的独立危险因素。用直径预测CLNM的最优临界值为8 mm。结论PTMC患者CLNM与多个因素相关，当患者年龄〈45岁、肿瘤直径≥7 mm、包膜受侵及多灶时，应行中央区淋巴结清扫。

ObjectiveTo investigate the related factors of central regional lymph node metastasis （CLNM） in patients with papillary thyroid microcarcinoma （PTMC） .MethodsThe clinical and pathological features of 550 cases of PTMC with clinical lymph node negative （cN0） were retrospectively analyzed. χ2 test and multivariate logistic regression analysis were used to analyze the related factors of CLNM. ROC curve was used to analyze tumor diameter and CLNM of PTMC.ResultsThe CLNM rate was 35.6%. Univariate analysis showed that patients aging less than 45 y （χ2=13.983, P〈0.001） , with tumor diameter≥7 mm （χ2=14.263, P〈0.001） , with capsule invasion （χ2=7.316, P=0.006） , multifocality （χ2=14.321, P〈0.05） and bilateral tumors （χ2=9.265, P=0.002） were more likely to have CLNM. Multivariate Logistic regression analysis showed that age 〈45 y, tumor diameter ≥7 mm, invasion of capsule and multifocal are all independent risk factors of CLNM for patients with PTMC. The optimal cutoff value of CLNM by diameter was 8 mm.ConclusionThe CLNM of PTMC is related to many factors.When the age of the patient is less than 45 y, the diameter of the tumor is more than 7 mm, the invasion of the capsule and the multifocal lesion, the central lymph node dissection should be performed.