甲状腺乳头状癌不同位置颈侧区淋巴结转移率及跳跃性转移特征分析

Analysis of lateral lymph node metastasis rate of papillary thyroid carcinoma in different location and characteristics of nodal skip metastasis

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)不同位置其颈侧区淋巴结转移率,研究颈侧区淋巴结跳跃性转移的危险因素。方法回顾分析73例术后经病理证实颈侧区淋巴结转移且手术方式为甲状腺全切除+双侧中央区淋巴结清扫+单侧择区颈侧区淋巴结清扫病例,甲状腺癌位置分为上、中、下部,统计颈侧区淋巴结转移率;依据术后中央区淋巴结有无转移分为对照组和跳跃转移组,通过单因素和多因素分析相关临床病理特征,得出跳跃性转移的危险因素。结果不同位置甲状腺癌仅在Ⅱ区转移率上有差异(P=0.027),位于上部的甲状腺癌容易发生跳跃性转移(P=0.001),且多转移至Ⅱ区(58.3%);跳跃性转移率为17.81%(13/73),跳跃性转移的危险因素为上部(OR=14.010,95%CI1.213~161.774)、原发癌单灶(OR=0.085,95%CI0.007-0.969),原发癌直径(OR=0.028,95%CI0.001-0.745)。结论跳跃性淋巴结转移并不少见,甲状腺癌位于上部、原发癌有无多灶及原发癌直径较小是跳跃性淋巴结转移的危险因素,上部癌更多转移至Ⅱ区,手术时应该引起重视。

Objective To explore the lateral cervical lymph node metastasis rate of papillary thyroid carcinoma (PTC) in different location and to investigate the risk factors of lateral cervical lymph node skip metastasis.Methods Retrospective analysis was performed on 73 PTC patients with lateral cervical lymph node metastasis proven by pathology and the surgical method was total thyroidectomy + bilateral central area lymph node dissection + selective lateral cervical lymph node dissection.The location of PTC was divided into the upper, middle and lower portion of the thyroid.The lateral cervical lymph node metastasis rate was analyzed.According to the central lymph node metastasis after operation, the patients were divided into a control group and a skip metastasis group.The risk factors of nodal skip metastasis were obtained by univariate and multivariate analysis of the clinicopathological characteristics.Results The metastasis rate of PTC in different locations was different only in zone Ⅱ(P=0.027).Tumors located in the upper portion of the thyroid was prone to nodal skip metastasis (P=0.001), and most of them metastasized to zone Ⅱ(58.3%).The rate of nodal skip metastasis was 17.81 %(13/73), and the risk factors for nodal skip metastasis were tumors located in the upper portion of the thyroid (OR: 14.010, 95% CI: 1.213-161.774), multiple focuses tumors (OR=0.085 , 95% CI 0.007-0.969), and small tumor diameter (OR: 0.028, 95% CI: 0.001-0.745).Conclusions Nodal skip metastasis is not uncommon in PTC.Tumors in the upper portion of the thyroid, multiple focuses tumors and smaller tumor diameter are the risk factors of nodal skip metastasis.Tumors located in the upper portion of the thyroid are easy to metastasize to zone Ⅱ.These risk factors should be taken into consideration during operation for patients with PTC.