甲状腺乳头状微小癌多灶性病变预测中央区淋巴结转移

Multifocal papillary thyroid microcarcinoma increases the risk of central lymph node metastasis

目的探讨甲状腺乳头状微小癌（papillary thyroid microcarcinoma，PTMC）中央区淋巴结转移（central lymph node metastasis, CLNM）的预测因素。方法回顾性分析2013年1月至2016年1月浙江省肿瘤医院头颈外科行中央区淋巴结清扫手术的PTMC 2 511例。单因素采用卡方检验，多因素采用二分类Logistic回归分析，分析年龄、性别、肿瘤大小、多灶性、腺外侵犯和伴有结节性甲状腺肿等因素与CLNM的相关性。结果单因素分析中，年龄、性别、肿瘤大小、多灶性、腺外侵犯和伴有结节性甲状腺肿等因素差异具有统计学意义。年龄〈45岁（P〈0.001，χ2=17.442），性别为（P〈0.001，χ2=17.029），肿瘤〈5 mm（P〈0.001，χ2=70.164.），腺外侵犯因素（P〈0.001，χ2=63.197）。伴有结节性甲状腺肿因素（P=0.017，χ2=5.611）。其中多灶因素差异具有统计学意义（P〈0.001，χ2=39.454）。多因素分析中：≥2个病灶PTMC的出现CLNM的风险是单灶PTMC的1.587倍。在多灶病变PTMC中≥3个病灶是2个病灶出现中央区淋巴结转移的近3倍（OR=2.730）。肿瘤〉5 mm（OR=1.926），伴有腺外侵犯（OR=1.606）。结论多灶性、肿瘤大小和腺外侵犯是PTMC出现CLNM的主要预测因素。其中≥3个以上的多灶是显著的预测因素。PTMC中央区淋巴结清扫的手术指征除了考虑肿瘤大小、腺外侵犯等常规因素外，尚需考虑多灶性因素。

ObjectiveTo investigate the predictive factors for central lymph node metastasis （CLNM） in papillary thyroid microcarcinoma （PTMC） .MethodsA retrospective study including 2511 cases of PTMC admitted from Jan. 2013 to Jan. 2016 were enrolled in our study. Chi-square test was used in univariate analysis. Logistic regression analysis was applied for multivariate analysis. The relation between age, sex, tumor size, multifocality, thyroidal extension, nodular goiter and central lymph node metastasis is analyzed.ResultsUnivariate analysis showed that age, sex, tumor size, multifocality, thyroidal extension and nodular goiter had statistical significance. Age less than 45 （P〈0.001, χ2=17.442） ; Male gender （P〈0.001, χ2=17.029） ; Tumor size less than 5 mm （P〈0.001, χ2=70.164.） ; Extrathyroid extension factor （P〈0.001, χ2=63.197） ; Nodular hyperplasia factor （P=0.017, χ2=5.611） . Multivariate analysis showed there was a significant relationship between multifocality and the central lymph node positivity. The odds ratio （OR） was 1.587 in patients with tumor foci ≥2 （P〈0.001） . While OR increased sharply near to 3 in patients withtumor foci ≥3 （OR=2.730） . Tumor size （OR=1.926） ; Extrathyroid extension （OR=1.606） .ConclusionsMultifocalty, tumor size and thyroidal extension are the main predicative factors for central lymph node metastasis in PTMC. Among them, tumor foci≥3 is an important predictor. Besides the conventional factors such as tumor size, thyroidal extension etc, multifocalty should also be taken into consideration.