甲状腺乳头状癌侧颈区淋巴结转移的相关因素分析

Risk factors analyses for lateral neck lymph node metastasis in papillary thyroid carcinoma

目的:探讨甲状腺乳头状癌侧颈区淋巴结转移的相关因素。方法:对145例甲状腺乳头状癌患者的临床资料进行回顾性分析,按照术后病理证实是否有侧颈区淋巴结转移进行分组。对临床特点及肿瘤B超声像图特征进行分析,探索预测甲状腺乳头状癌侧颈区淋巴结转移的危险因素。结果:单因素分析显示,侧颈区淋巴结转移与肿瘤直径(原发灶病理最大径)>1.0cm、多灶、肿瘤位于腺体上极、Ⅵ区淋巴结转移及B超显示肿瘤内部和(或)周边可见血流有相关性(P<0.05),与性别、年龄、是否侵及被膜、形态是否规则、边界是否清晰、有无微钙化无相关性(P>0.05)。多因素分析显示,肿瘤直径>1.0cm、位于腺体上极,Ⅵ区淋巴结转移是侧颈区淋巴结转移的危险因素(OR=6.250、4.881、5.222,P<0.05)。且当上述危险因素至少暴露2个时,侧颈区淋巴结转移率明显增加(95%CI 23~53)。结论:肿瘤直径>1.0cm、位于腺体上极、Ⅵ区淋巴结转移是预测侧颈区淋巴结转移的危险因素。对存在以上高危因素的甲状腺乳头状癌患者,建议重视术前辅助检查及术中探查,酌情行择区性淋巴结清扫术。

Objective:To study the risk factors for the lateral neck lymph node metastasis(LNM)in patients with papillary thyroid carcinoma(PTC).Method:Total 145 cases of papillary thyroid carcinoma patients were reviewed.These patients were divided into the following 2 groups:a lateral LNM-positive group and a lateral LNMnegative group.Clinical factors and tumor ultrasound characteristics were recorded,and the final pathology results were recorded as well.Result:Univariate and multivariate analyses indicated that primary tumor size(pathological diameter)>1.0 cm,upper portion location and lymph node metastasis in central neck were the three risk factors for lateral LNM of PTC(OR=6.250,4.881,5.222,P<0.05).The lymph node metastasis in the lateral neck was not correlated obviously with gender,age,capsuleinvasion,multifocality and tumor ultrasonic characteristics(including ill-defined and irregular in shape,calcification,hypervascularized).The probability of lateral LNM was then calculated according to the number of risk factors present in each of the 145 patients,using the three factors.When two or more factors were present,the probability increased up to 38.1%(95%CI 23-53).Conclusion:The present study provides that lateral LNM occurs mainly in patients,with a tumor size(pathological diameter)diameter>1.0 cm,with the primary tumor located in the upper part of the lobe and positive central compartment lymph node metastasis.The risk increased up when at least two of the three factors were present.So it needs to pay attention to the high risk factors seriously which effect lateral neck lymph node metastasis in patients with PTC,combined with ultrasonic characteristics of lateral cervical lymph node or more meticulous evaluations,to establish the lymph node dissection individually.