单侧甲状腺乳头状癌对侧中央区淋巴结转移的临床危险因素分析

Clinical risk factors for contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma

目的分析单侧甲状腺乳头状癌(unilateral papillary thyroid carcinoma,uPTC)发生对侧中央区淋巴结(contralateral central lymph nodes,Cont-CLNs)转移的临床高危因素,探讨Cont-CLNs清扫指征。方法回顾性分析2010年1月~2017年12月行甲状腺全切及双颈中央区淋巴结清扫的136例uPTC的临床病例资料,采用单因素分析和多因素Logistic回归的方法研究Cont-CLNs转移与uPTC患者各项临床病理特征的关系,构建Cont-CLNs转移的风险预测模型,ROC曲线分析其预测价值。结果本组136例uPTC患者中,患侧中央区淋巴结(ipsilateral central lymph nodes,Ipsi-CLNs)转移率48.53%(66/136),Cont-CLNs转移率19.85%(27/136),Ipsi-CLNs未转移而Cont-CLNs转移(跳跃性转移)为5.15%(7/136)。单因素结果表明,ContCLNs转移与uPTC患者的性别、病灶部位、肿瘤最大径、被膜侵犯及Ipsi-CLNs转移有关(P<0.05),而与年龄、病灶数目、合并桥本氏甲状腺炎及侧颈淋巴结转移无明显关系(P>0.05)。Logistic回归结果显示,性别(男性)、被膜侵犯及Ipsi-CLNs转移是Cont-CLNs转移的独立预测因素,该模型预测Cont-CLNs转移的曲线下面积(AUC)为0.764(95%置信区间为0.658～0.871),当取约登指数最大时,其预测的敏感性为59.26%,特异性为83.49%。结论单侧甲状腺乳头状癌伴有男性、被膜侵犯及Ipsi-CLNs转移等高危特征时应警惕Cont-CLNs转移,可考虑行Cont-CLNs清扫。

OBJECTIVE To invest igate the clinical risk factors of contralateral central lymph node metastasis（Cont-CLNs） in unilateral thyroid papillary carcinoma（uPTC） and to explore the indications of ContCLNs dissection. METHODS Clinicopathologicl data of 136 uPTC patients who underwent total thyroidectomy and bilateral central neck dissection from January 2010 to December 2017 was retrospectively analyzed. The univariate and multivariate analysis were used to study the relationship between Cont-CLNs metastasis and the clinicopathologic characteristics of uPTC patients. A risk model for Cont-CLNs metastasis was constructed to analyze its predictive value by ROC curve. RESULTS In the 136 patients with uPTC,the rate of metastasis to ipsilateral central lymph nodes（IpsiCLNs） was 48.53%（66/136）, the rate of Cont-CLNs metastasis was 19.85%（27/136）, and the rate of Cont-CLNs metastasis（skip metastasis） without positive Ipsi-CLNs was 5.15%（7/136）.The univariate analysis showed that Cont-CLNs metastasis was related to the gender, lesion location, tumor size, capsular invasion and Ipsi-CLNs metastasis（P〈 0.05）, whereas there was no signif icant relationship between Cont-CLNs metastasis and other clinicopathological characteristics（ie,age, number of lesions, Hashimoto＇s thyroiditis and lateral lymph node metastasis）. The result of Logistic regression model revealed that male, capsular invasion and Ipsi-CLNs metastasis were independent predictors of Cont-CLNs metastasis. The area under the curve（AUC） of model for predicting Cont-CLNs metastasis was 0.764（95%CI： 0.658-0.871）, while the sensitivity and specificity was 59.26% and 83.49% respectively. CONCLUSION Cont-CLNs metastasis should be considered when unilateral thyroid papillary carcinoma is associated with high-risk features such as male, capsular invasion and Ipsi-CLNs metastasis,and then Cont-CLNs dissection can be considered.