228例甲状腺微小乳头状癌临床特征及颈部淋巴结转移危险因素分析

Clinical characteristics of papillary thyroid microcarcinoma and risk factors for cervical lymph node metastasis:a clinical analysis of 228 cases

背景与目的:甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)的发病率不断增加,总体预后较好,但在临床诊治过程中存在争议。通过分析患者资料,总结PTMC的临床特征及危险因素,以指导临床精准治疗。方法:回顾性分析蚌埠医学院第一附属医院2015年1月—2017年12月间行手术治疗的PTMC患者的临床病理学资料。结果:在228例患者中,109例发生中央区淋巴结和(或)颈侧区淋巴结转移(47.81%),单因素分析结果显示,患者性别、年龄、肿瘤最大径及原发灶数目与颈部淋巴结转移相关(P均<0.05);二元logistic多因素分析结果显示,男性患者、年龄<45岁、肿瘤最大径>4 mm及多中心病灶是PTMC颈部淋巴结转移的独立危险因素(P均<0.05)。结论:PTMC虽然肿瘤较小但不等同于淋巴结转移风险小,特别对于男性患者、年龄<45岁、肿瘤最大径>4 mm及多中心病灶患者应积极进行外科手术干预。

Background and purpose:The incidence of papillary thyroid microcarcinoma(PTMC)is increasing,and the overall prognosis is good.However,there is controversy in clinical diagnosis and treatment of the disease.In this study,we summarized the clinical characteristics and risk factors of PTMC by analyzing the data of patients in order to guide clinical precision treatment.Methods:We performed retrospective analysis of clinical and pathological data of patients with PTMC who underwent surgery from Jan.2015 to Dec.2017 in the First Affiliated Hospital of Bengbu Medical College.Results:Of the 228 patients,109 had central lymph node and/or lateral cervical lymph node metastasis(47.81%).Univariate analysis showed that gender,age,maximum tumor diameter and number of primary tumors were associated with cervical lymph node metastasis(all P value<0.05).Multivariate logistic analysis showed that male patient,less than 45 years of age,tumor maximum diameter?4 mm and multi-center lesion were independent risk factors for cervical lymph node metastasis of PTMC(all P value<0.05).Conclusion:Although PTMC is small,it does not indicate lower risk of lymph node metastasis,particularly patient who is male,younger than 45 years,whose tumor maximum diameter?4 mm or who has multi-center lesion should be actively involved in surgical intervention.