cN0甲状腺微小乳头状癌中央区淋巴结转移相关因素分析

Related factors of central lymph node metastasis in cN0 papillary thyroid microcarcinoma

目的分析cN0甲状腺微小乳头状癌发生中央区淋巴结转移的影响因素。方法收集2016年4月~2019年12月同一诊疗组收治的符合入组标准的cN0甲状腺微小乳头状癌患者331例。其中男性91例,女性240例,年龄范围18~68岁,平均年龄为41.6岁。入组病例中行单侧腺叶+同侧中央区淋巴结清扫术者255例,甲状腺全切+双侧中央区淋巴结清扫术者76例。数据采用SPSS 20.0统计软件分析,中央区淋巴结转移的单因素分析采用χ~2检验,多因素分析采用Logistic回归分析。结果单因素分析结果,肿瘤直径是否≥5 mm、肿瘤是否位于甲状腺峡部,是否为双侧甲状腺腺叶病变、肿瘤是否侵犯甲状腺被膜是cN0甲状腺微小乳头状癌发生中央区淋巴结转移的影响因素。多因素回归分析结果,肿瘤最大直径≥5 mm、肿瘤位于甲状腺峡部、肿瘤侵犯甲状腺被膜是cN0甲状腺微小乳头状癌发生中央区淋巴结转移的独立危险因素。结论肿瘤最大直径≥5 mm、肿瘤位于甲状腺峡部、肿瘤侵犯甲状腺被膜是甲状腺微小乳头状癌中央区淋巴结转移的高危因素,建议行预防性中央区淋巴结清扫。

OBJECTIVE To analyze the related factors of the central lymph node metastasis(CLNM) for cN0 papillary thyroid microcarcinoma(PTMC).METHODS The clinical data of 331 cases with PTMC in cN0 who were enrolled in the same treatment group of the Beijing Tongren Hospital from April 2016 to December 2019 was analyzed retrospectively.Among them,91 were males and 240 were females,aged 18-68 years,the average age is 41.6 years.There were 255 patients who underwent unilateral thyroidectomy plus ipsilateral central lymph node dissection.There were 76 patients who underwent total thyroidectomy plus bilateral central lymph node dissection.The data were analyzed by statistical software SPSS 20.0.The univariate analysis of CLNM was performed by chi-square test,and the multivariate analysis was performed by logistic regression analysis.RESULTSUnivariate analysis showed that whether the diameter of the tumor was ≥5 mm,whether the tumor was located in the thyroid isthmus,whether it was bilateral thyroid lobe lesions,and whether the tumor invaded the thyroid capsule were the influencing factors of CLNM of TPMC in cN0.Multivariate regression analysis showed that tumor diameter ≥5 mm,tumor located in thyroid isthmus and tumor invading thyroid capsule were independent risk factors for CLNM of TPMC in cN0.CONCLUSION For the cN0 patients with PTMC,if the tumor size ≥5 mm,the location of tumor in thyroid isthmus,or thyroid capsule invasion,the prophylactic central neck dissection was recommended.