多因素Logistic分析单灶甲状腺微小乳头状癌中央区淋巴结转移的危险因素

Multivariate logistic analysis of risk factors analysis of lymph node metastasis in central region of single-foci thyroid micropapillary carcinoma

目的:探索影响单灶甲状腺微小乳头状癌(PTMC)颈部中央区淋巴结转移(CLNM)的相关因素。方法:回顾性分析251例单灶PTMC病患,统计病患的基本情况及超声特征,采用单因素χ2检验及多因素Logistic回归分析PTMC病患CLNM的相关因素。结果:术前超声检查对PTMC病患CLNM的灵敏性、特异性分别为32.4%(22/68)、95.6%(175/183)。单因素分析,单灶PTMC病患CLNM的相关因素表明病患在性别、年龄、肿瘤最大径、微小钙化及侵出包膜方面比较,差异具有统计学意义(P<0.05);在血流、肿瘤位置、纵横比、回声、边界及合并桥本氏甲状腺炎方面比较,差异无统计学意义(P>0.05)。进一步多因素Logistic回归分析表明,年龄<45岁、肿瘤最大径>5 mm、微小钙化及侵出包膜与单灶PTMC病患CLNM密切相关。结论:超声影像对评估单灶PTMC是否有CLNM具有重要作用;对于年龄<45岁、超声征象中肿瘤最大径>5 mm、微小钙化及侵出包膜的PTMC病患应预防性清扫颈部中央区淋巴结。

Objective:To investigate the risk factors of lymph node metastasis in the central region(CLNM)of single thyroid micropapillary carcinoma(PTMC).Methods:251 patients with PTMC were retrospectively analyzed.The basic conditions and ultrasound characteristics of the patients were statistically analyzed,and the related factors of CLNM in PTMC patients were analyzed by single factorχ2 test and multiple Logistic regression.Results:The sensitivity and specificity of preoperative ultrasound for PTMC central lymph node metastasis were 32.4%(22/68)and 95.6%(175/183),respectively.Univariate analysis of the factors related to lymph node metastasis in the central region of PTMC showed significant differences in gender,age,tumor diameter,microcalcification,and capsule invasion(P<0.05),but no significant differences in blood flow,tumor location,aspect ratio,boundary,echo,and combined with hashimoto thyroiditis(P>0.05).Logistic regression analysis showed that CLNM was closely related to age<45 years old,tumor diameter of>5 mm,microcalcification,and capsule invasion.Conclusion:Ultrasound imaging plays an important role in the evaluation of lymph node metastasis in the central cervical region of PTMC.Our findings indicate that prophylactic central lymph node dissection should be recommend in patients<45 years of age,tumor diameter of>5 mm,microcalcification,and capsule invasion.