单灶性甲状腺乳头状癌的临床、血清学和超声影像特征及中央区淋巴结转移危险因素分析

Clinical serological and ultrasonographic characteristics of single focal papillary thyroid carcinoma and analysis of risk factors for central lymph node metastasis

目的探究单灶性甲状腺乳头状癌(PTC)的临床、血清学和超声影像特征及中央区淋巴结转移(CLNM)相关的危险因素。方法选择2015年2月至2019年2月收治的246例单灶性PTC患者,其中男性146例,女性100例,年龄32~81岁,平均年龄63.33岁。收集患者的临床、血清学及超声影像特征,根据组织病理学检查结果判断有无CLNM,分析与临床、血清及超声因素间关系。确定影响颈部CLNM的独立危险因素。结果经病理诊断证实,246例患者中有86例(34.96%)发生CLNM,160例(65.04%)未发生CLNM,术前超声诊断CLNM真阳性79例,真阴性143例,假阳性7例,假阴性17例,灵敏度为91.86%,特异度为89.38%,准确率为90.24%。发生CLNM与未发生CLNM的患者在年龄、性别、甲状腺球蛋白(Tg)、术前甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)、结节位置、肿瘤最大直径、紧贴被膜、回声上,差异均有统计学意义(P<0.05)。将年龄、性别、Tg、TPOAb、TGAb、结节位置、肿瘤最大直径、紧贴被膜、回声带入Logistic回归方程计算发现,上述因素比值比(OR)均>1,均是引起单灶性PTC患者发生CLNM的影响因素。结论单灶性PTC患者发生CLNM的危险因素为年龄、性别、Tg、TPOAb、TGAb、结节位置、肿瘤最大直径、紧贴被膜、回声,临床一旦发现,应考虑行中央区淋巴结清扫。

Objective To explore the clinical serological and ultrasonographic features of papillary thyroid carcinoma(PTC),and risk factors for central lymph node metastasis(CLNM).Methods From February 2015 to February 2019,a total of 246 patients with single-focus PTC were enrolled,which included 146 males and 100 females,aged 32-81 years old with mean age of 63.33 years old.The clinical,serological and ultrasound imaging features were collected,and the presence or absence of CLNM was determined based on results of histopathological analysis,and relationship between CLNM and clinical,serum and ultrasound factors was analyzed.The independent risk factors for CLNM in the neck were identified.Results The pathology confirmed that CLNM occurred in 86(34.96%)of 246 cases,and without CLNM in 160(65.04%).The preoperative ultrasound diagnosis showed that 79 cases of CLNM were true positive,143 were true negative,7 were false positive and 17 were false negative.The sensitivity was 91.86%,specificity was 89.38%and accuracy was 90.24%.There were statistically significant in age,gender,thyroglobulin(Tg),preoperative thyroid peroxidase antibody(TPOAb),thyroglobulin antibody(TGAb),nodule location,tumor maximum diameter,cling capsule,echo between patients with CLNM and without CLNM(P<0.05).Logistic regression equation was used to calculate age,gender,Tg,TPOAb,TGAb,nodule location,tumor maximum diameter,cling capsule and echo.The odds ratio(OR)of all the above factors>1,which were all influential factors for CLNM in patients with single-focal PTC.Conclusion It is demonstrated that the risk factors of CLNM in patients with single-focus PTC are age,sex,Tg,TPOAb,TGAb,nodule location,tumor maximum diameter,cling capsule and echo.The lymph node dissection of central area should be performed as soon as above clinical findings discovered.