单灶性甲状腺乳头状癌中央区淋巴结转移危险因素分析

Risk factors of central neck lymph node metastasis following solitary papillary thyroid carcinoma

目的分析单灶性甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床、血清学及超声影像特征,寻找与颈部淋巴结转移相关的危险因素。方法回顾性分析2016年1-9月于本院行甲状腺手术且术后病理证实为单灶PTC的患者1 174例,按有无中央区淋巴结转移(central lymph node metastasis,CLNM)分为CLNM阳性组及CLNM阴性组,应用单因素及多因素回归分析两组病例的临床及病灶超声特征,确定影响颈部中央区淋巴结转移的独立危险因素,并建立列线图预测模型。结果1 174例患者中,469例(39.9%)表现为CLNM阳性。单因素分析显示:年龄、性别、术前甲状腺球蛋白(Tg)、甲状腺过氧化物酶抗体(TPOAb)、肿瘤最大径、位置、紧贴甲状腺被膜、回声、纵横比、声晕、微钙化与CLNM相关(P<0.05)。多因素分析显示年龄<55岁、男性、Tg≥20 μg/L、TPOAb<1 kU/L、肿瘤最大径>10 mm、微钙化为CLNM的独立危险因素。基于逻辑回归筛选的独立危险因素建立列线图,AUC为0.714,特异性为73.1%,敏感性为59.7%。结论单灶PTC患者年龄较小、男性、术前TPOAb水平低、Tg水平较高、超声图像中肿瘤较大、微钙化为中央区淋巴结转移的独立危险因素。

Objective To evaluate the risk factors in terms of clinical characteristics, serological indicators and sonographic features regarding thyroid papillary carcinoma (PTC) for the central neck lymph node metastasis. Methods One thousand one hundred and seventy-four patients accepted thyroid cancer surgery at Fudan University Shanghai Cancer Center from January to September 2016 were enrolled. All patients were confirmed to be solitary PTC in paraffin wax pathology after thyroidectomy.Meanwhile, the status of central neck lymph node metastasis was determined referring to postoperative pathology. All features of the PTC lesion in terms of clinical, serological and sonographic features were evaluated for the association with central neck lymph node metastasis using univariate and multivariate logistic regression analysis. Meanwhile, a nomogram model was established for the determined risk factors. Results Out of 1 174 patients, 469 patients (39.9%) presented central neck lymph node metastasis, univariate analysis showed that age, gender, preoperative thyroglobulin(Tg) and thyroid peroxidase antibody(TPOAb), maximum diameter, location, close to the thyroid capsule, AP/TR, echo, acoustic halo, and presence of microcalcification were related with CLNM (P<0.05). Multivariate logistic regression analysis demonstrated that less than 55 years-old, male, Tg higher than 20 μg/L, TPOAb less than 1 kU/L, maximum diameter larger than 10 mm, and presence of microcalcification were independent risk factors for CLNM. The nomogram was established based on independent risk factors determined by the logistic regression with the AUC 0.714, specificity 73.1%, and sensitivity 59.7%. Conclusions For patients with single focal PTC lesion, younger age, male, higher Tg, lower TPOAb, and larger lesions containing microcalcificatin on ultrasound are associated with central neck lymph node metastasis.