甲状腺乳头状癌中央区淋巴结转移的危险因素分析

Risk factors for central neck lymph node metastases of papillary thyroid carcinoma

目的探讨甲状腺乳头状癌(PTC)中央区淋巴结转移(CLNM)的危险因素。方法选取2016年8月—2018年12月在锦州医科大学附属第一医院行手术治疗的303例PTC患者临床资料,回顾性分析患者性别、年龄、体重指数(BMI)、肿瘤最大直径、肿瘤数量、肿瘤位置、被膜侵犯情况、甲状腺球蛋白抗体(TgAb)及促甲状腺激素(TSH)等因素对CLNM的影响。结果303例患者中,116例发生CLNM,总转移率为39.27%。单因素分析结果显示,性别、年龄、BMI、肿瘤最大直径、肿瘤数量、是否被膜侵犯及CLNM率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,性别[O^R=0.454(95%CI:0.224,0.921)]、年龄[O^R=0.957(95%CI:0.936,0.978)]、肿瘤最大直径[O^R=1.438(95%CI:1.117,1.852)]及被膜侵犯[O^R=0.399(95%CI:0.230,0.691)]是PTC患者发生CLNM的危险因素。受试者工作特征曲线显示,年龄为45.5岁、肿瘤最大直径为0.75cm时约登指数最大,对应的曲线下面积分别为0.643和0.691,敏感性分别为0.620(95%CI:0.580,0.706)和0.695(95%CI:0.632,0.750),特异性分别为0.682(95%CI:0.580,0.706)和0.720(95%CI:0.632,0.750)。结论PTC发生CLNM与多个因素有关,当患者为男性、年龄<45.5岁、肿瘤最大直径≥0.75 cm及存在被膜侵犯时,CLNM发生可能性大,建议行中央区淋巴结清扫。

Objective To investigate the risk factors of central lymph node metastasis(CLNM)in papillary thyroid carcinoma(PTC).Methods The clinical data of 303 patients with PTC who underwent surgical treatment in our hospital from August 2016 to December 2018 were collected.The influence of sex,age,body mass index(BMI),tumor maximum diameter,tumor number,tumor location,membrane infiltration,thyroglobulin antibody(TgAb)and thyroid stimulating hormone(TSH)on CLNM in PTC were retrospectively analyzed.Results The total metastatic rate of CLNM was 39.27%in 116 out of 303 patients.Univariate results showed that sex,age,BMI,tumor maximum diameter,number of tumors and membranous infiltration were associated with CLNM.The differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that sex[O^R=0.454,(95%CI:0.224,0.921)],age[O^R=0.957,(95%CI:0.936,0.978)],tumor maximum diameter[Ol^R=1.438,(95%CI:1.117,1.852)]and the membrane infiltration[O^R=0.399,(95%CI:0.230,0.691)]were risk factors for CLNM in patients with PTC.Subject operating characteristic curve(ROC)analysis showed that the Yoden index was the largest when the age was 45.5 years old and the maximum diameter of the tumor was 0.75cm.The area under the curve were 0.643 and 0.691;sensitivity was 0.526(95%CI:0.580,0.706)and 0.845(95%CI:0.632,0.750);specificity was 0.711(95%CI:0.580,0.706)and 0.471(95%CI:0.632,0.750),respectively.Conclusions The occurrence of CLNM in PTC is related to several factors.When the patient is male,age<45.5,tumor maximum diameter≥0.75 cm and membranous infiltration,CLNM is more likely to occur and it is recommended that the central lymph node dissection(CLND)should be performed.