甲状腺微小乳头状癌发生隐匿性颈部淋巴结转移的危险因素分析

Analysis of the Risk Factors of Occult Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

目的:分析甲状腺微小乳头状癌(PTMC)发生隐匿性颈部淋巴结转移的危险因素。方法:收集2013-2017年于青岛大学附属医院确诊的PTMC患者共1524例,按其术前、术后是否有颈部淋巴结转移分为显性淋巴结转移、隐匿性淋巴结转移及无淋巴结转移三组,比较各组之间的临床病理特征,包括性别(男性)、年龄、肿瘤大小、双叶、多灶、侵犯包膜、合并桥本病、术前TSH水平等是否具有差异性。结果:单因素分析结果显示:与无淋巴结转移患者相比,隐匿性淋巴结转移组男性患者比例、年龄、肿瘤大小、肿瘤累及双叶、多灶比例均有统计学差异(P<0.05),其中隐匿性淋巴结转移组中的发病年龄较低(P<0.05),合并桥本病的比率无显著差异(P>0.05);与显性淋巴结转移相比,隐匿性淋巴结转移肿瘤大小、合并多灶及合并病理桥本病的转移率较后者低(P<0.05)。多因素分析表明以无淋巴结转移的患者为对照组,男性患者、年龄、大小、多灶为隐匿性淋巴结转移的危险因素(OR值分别为0.525,1.033,0.169,0.562);与隐匿性淋巴结转移相比,合并桥本病的患者发生显性颈部淋巴结转移的风险更高,而发病年龄较前者大(OR值分别为0.370,0.979)。结论:男性、肿瘤累及双叶、多灶者为PTMC早期淋巴结转移的危险因素,合并桥本病者发生显性颈部淋巴结转移的风险更高;但没有发现桥本病与隐匿性颈部淋巴结转移存在相关性。

Objective： To investigate the risk factors of occult cervical lymph node metastasis in papillary thyroid microcarcinoma.Methods： The clinical records of 1524 cases of PTMC patients diagnosed in the Affiliated Hospital of Qingdao University from 2013 to2017 were reviewed.The pathological and clinical characteristics were analyzed of dominant lymph node metastasis,occult lymph node metastasis and patients without lymph node metastasis,including gender（male）,age,number of lesions,capsular invasion and Hashimoto＇s disease.Results： In the univariate analysis,patients without lymph node metastasis,age,tumor with double blade,multifocality had statistic difference（P〈0.05）.And the age of the occult lymph node metastasis group is lower（P〈0.05）,there was no significant difference in the ratio of Hashimoto＇s disease（P〉0.05）.Compared with dominant lymph node metastases,patients with occult lymph node metastasis had lower tumor size,multifocality and the pathological Hashimoto＇s disease（P〈0.05）.Multivariate analysis showed that gender,age,tumor size and multifocality were risk factors for occult lymph node metastasis（OR=0.525,1.033,0.169,0.562）.Compared with the occult lymph node metastasis,patients with Hashimoto＇s disease had a higher risk of dominant cervical lymph node metastasis,and the age of onset was larger than that of the former（OR=0.370,0.979）.Conclusion： The risk factors for early lymph node metastasis of PTMC were male,tumor involving double lobe S and multifocality.The risk of dominant cervical lymph node metastasis was higher in patients with Hashimoto＇s disease,but there was no correlation between Hashimoto＇s disease and occult cervical lymph node metastasis.