单灶性甲状腺乳头状微小癌患者Ⅵ、Ⅶ淋巴结转移规律及危险因素分析

Metastasis Rule and Risk Factors of Cervical Central Group (Ⅵ and Ⅶ Region) Lymph Node in Patients with Unifocal Papillary Thyroid Microcarcinoma

目的探讨单灶性甲状腺乳头状微小癌(PTMC)患者Ⅵ、Ⅶ区淋巴结转移规律及其危险因素。方法回顾性分析2017年1月-2018年5月青岛大学附属医院收治的246例肿瘤最大径≤10 mm的PTMC患者的临床病理资料,包括性别、年龄、肿瘤部位、是否腺外侵犯等,总结肿瘤最大径≤10 mm的PTMC患者的中央区淋巴结转移(CLNM)规律,并应用χ^2检验、多元logistic回归分析其危险因素。结果 246例肿瘤最大径≤10 mm的单灶性PTMC患者中,发生Ⅵ、Ⅶ区淋巴结转移74例(30.1%),预防性Ⅵ、Ⅶ区淋巴结清扫淋巴结个数为0~24个。单因素分析结果显示,单发灶(肿瘤最大径≥5 mm)、包膜侵犯、性别、年龄(<45岁)是单灶性PTMC(肿瘤最大径≤10 mm)患者Ⅵ、Ⅶ区淋巴结转移的危险因素(P<0.05)。多因素分析结果显示,单发灶(肿瘤最大径≥5 mm)、包膜侵犯、男性均是PTMC(肿瘤最大径≤10 mm)患者发生Ⅵ、Ⅶ区淋巴结转移的独立危险因素(P<0.05)。结论肿瘤最大径不小于5 mm、包膜侵犯、男性的单灶性PTMC患者较易发生Ⅵ、Ⅶ区淋巴结转移,建议预防性清扫Ⅵ、Ⅶ区淋巴结。

Objective To study the metastasis rule and risk factors of cervical central group(Ⅵ and VII region)lymph node in patients with unifocal papillary thyroid microcarcinoma. Methods The clinical data of 246 patients with papillary thyroid microcarcinoma and tumor maximum diameter≤10 mm from Qingtao College Affiliated Hospital from Jan, 2017 to May, 2018 were analyzed retrospectively, including gender, age, tumor location and extrathyroidal invasion. The metastasis rule of cervical central group lymph node was summarized, and risk factors were analyzed through χ^2 test and logistic regression. Results The number of patients with cervical central group lymph node metastasis was 74(30.1%). The average number of lymph nodes in prophylactic lymph node dissection ranged from 0 to 24. Univariate analysis showed that single focus(tumor maximum diameter≥5 mm), extrathyroidal invasion, gender and age(<45 years old) were risk factors of CLNM(P<0.05). Multivariate analysis showed that single focus(tumor maximum diameter≥5 mm), extrathyroidal invasion,and male were independent risk factors of CLMM in PTMC(tumor maximum diameter≤5 mm)patients(P<0.05). Conclusion Prophylactic central lymph node dissection may be more valuable for male PTMC(tumor maximum diameter≥5 mm)patients with unifocal tumors and extrathyroidal invasion.