影响甲状腺微小癌颈淋巴结转移的危险因素分析

Analysis of Risk Factors Affecting Cervical Lymph Node Metastasis of Thyroid Microcarcinoma

目的研究影响甲状腺微小癌(TMC)发生颈淋巴结转移(LNM)的危险因素及LNM对患者预后的影响。方法选取147例TMC患者临床资料进行回顾性分析,根据病理结果将患者分为转移组和对照组,采集2组临床信息并进行比较,采用多因素Logistics回归分析研究影响LNM发生的危险因素,同时随访患者术后5年复发和生存情况。结果手术病理结果显示,147例TMC患者中发生LNM者56例(38.10%),其中颈中央区淋巴结转移53例(36.05%);实施侧颈淋巴结清扫的42例患者中发生转移者34例(80.95%),其中31例(73.81%)同时伴有中央区淋巴结转移,另有3例(7.14%)为跳跃式转移。多因素Logistic回归分析显示,TMC肿瘤最大径>0.5 cm、多病灶、被膜受累及腺外侵犯是LNM发生的独立危险因素(P<0.05)。随访结果显示,2组术后5年复发率分别为26.8%和16.5%(P>0.05),生存率分别为80.4%和87.9%(P>0.05)。结论TMC发生LNM风险较高,其主要危险因素包括肿瘤最大径>0.5 cm、多病灶、被膜受累及腺外侵犯。此外,LNM可能对患者预后造成不利影响。

Objective To study the risk factors affecting cervical lymph node metastasis(LNM)in thyroid microcarcinoma(TMC)and effects of LNM on the prognosis of patients.Methods The clinical data of 147 patients with TMC were retrospectively analyzed.According to the pathological results,the patients were divided into metastasis group and the control group.The clinical information of the 2 groups were collected and compared.Multivariate logistics regression analysis was used to study the risk factors affecting LNM occurrence,and the recurrence and survival at 5 years after operation were followed up.Results The results of surgical pathology showed that there were 56 cases(38.10%)of LNM among 147 patients with TMC,including 53 cases(36.05%)of central lymph node metastases.There were 34 cases(80.95%)of metastases among 42 patients who underwent lateral cervical lymph node dissection,including 31 cases(73.81%)of central lymph node metastases and 3 cases(7.14%)of skip metastases.Multivariate Logistics regression analysis showed that maximum diameter of TMC tumor>0.5 cm,multiple lesions,envelope involvement and extra-glandular invasion were independent risk factors for LNM(P<0.05).Follow-up results showed that the recurrence rates at 5 years after operation in the 2 groups were 26.8%and 16.5%(P>0.05),and the survival rates were 80.4%and 87.9%(P>0.05).Conclusion The risk of LNM is high in TMC.The main risk factors include tumor maximum diameter>0.5 cm,multiple lesions,envelope involvement and extra-glandular invasion.In addition,LNM may adversely affect the prognosis of patients.