cN0期甲状腺乳头状微小癌大容量中央区淋巴结转移的危险因素

Risk factors for large-volume central neck lymph node metastasis in cN0 papillary thyroid microcarcinoma

目的:探讨c N0期甲状腺乳头状微小癌(PTMC)中央区淋巴结转移(CLNM),尤其是大容量淋巴结转移(LV-LNM,转移数目>5枚)的危险因素。方法:回顾性分析512例行甲状腺全切或腺叶及峡部切除加中央区淋巴结清扫术的c N0期PTMC患者的临床资料,并根据CLNM转移情况将患者分为LV-LNM组和非LV-LNM组,分析c N0期PTMC患者CLNM及LV-LNM的危险因素。结果:512例患者中女415例(81.1%),男97例(18.9%),CLNM阳性者178例(34.8%),LV-LNM者21例(4.1%)。单因素分析显示,性别、年龄、癌灶直径、多灶性肿瘤、腺外侵犯及BRAFV600E基因突变与CLNM有关(均P<0.05);性别、年龄、多灶性肿瘤及腺外侵犯与LV-LNM有关(均P<0.05)。多因素分析显示,男性(OR=1.451,95%CI=1.030~2.044,P=0.033)、年龄<40岁(OR=1.720,95%CI=1.289~2.295,P=0.000)、癌灶直径>0.5 cm(OR=1.677,95%CI=1.218~2.309,P=0.002)和多灶性肿瘤(OR=1.872,95%CI=1.384~2.532,P=0.000)是CLNM的独立危险因素;男性(OR=2.852,95%CI=1.773~4.588,P=0.000)、年龄<40岁(OR=1.913,95%CI=1.434~2.552,P=0.000)及多灶性肿瘤(OR=1.579,95%CI=1.161~2.148,P=0.004)是LV-LNM的独立危险因素。结论:性别、年龄、癌灶直径和多灶性肿瘤是PTMC患者发生CLNM的高危因素,而男性、年龄<40岁的多灶性c N0期PTMC患者更容易发生LV-LNM,应积极行预防性中央区淋巴结清扫术。

Objective:To investigate the risk factors for central lymph node metastasis(CLNM),especially the large-volume metastasis(LV-LNM,number of metastatic lymph nodes>5)in patients with c N0 papillary thyroid microcarcinoma(PTMC).Methods:The clinical data of 512 patients with c N0 PTMC undergoing total thyroidectomy or lobectomy plusisthmusectomy plus prophylactic central neck dissection were retrospectively analyzed,and the patients were divided into LV-LNM group and non-LV-LNM group according to the number of CLNM.The risk factors for CLNM and LV-LNM in patients with c N0 PTMC were identified.Results:Of the 512 patients,415 cases(81.1%)were females and 97 cases(18.9%)were males;CLNM occurred in 178 cases(34.8%)and LV-LNM was found in 21 cases(4.1%).Univariate analysis showed that sex,age,tumor size,multiple lesions,extrathyroidal invasion and BRAFV600E mutation were significantly associated with CLNM(all P<0.05);sex,multiple lesions and extrathyroidal invasion were significantly associated with LV-LNM(all P<0.05).Multivariate analysis identified that males(OR=1.451,95%CI=1.030–2.044,P=0.033),age<40 years(OR=1.720,95%CI=1.289–2.295,P=0.000),tumor size>0.5 cm(OR=1.677,95%CI=1.218–2.309,P=0.002),multiple lesions(OR=1.872,95%CI=1.384–2.532,P=0.000)were risk factors for CLNM;males(OR=2.852,95%CI=1.773–4.588,P=0.000),age<40 years(OR=1.913,95%CI=1.434–2.552,P=0.000)and multiple lesions(OR=1.579,95%CI=1.161–2.148,P=0.004)were risk factors for LV-LNM.Conclusion:Sex,age,tumor size and multifocality are risk factors for CLNM in PTMC patients.Prophylactic central neck dissection should be aggressively performed in males and those with age<40 years or multiple lesions,because these patients may be more prone to LV-LNM.