甲状腺乳头状癌前上纵隔淋巴结转移临床病理特征初步分析

Preliminary analysis of the anterior superior mediastinal lymph node metastasis in thyroid papillary carcinoma

目的探讨肿瘤位置、最大直径及甲状腺外浸等临床病理特征与甲状腺癌前上纵隔淋巴结转移的关系。方法研究分析初次手术治疗的60例甲状腺乳头状癌患者临床及病理资料,运用检验临床病理特征与前上纵隔淋巴结阳性率的相关性。结果肿块位置、最大直径、数量、腺体外侵、受累腺叶数及Ⅵ区淋巴结转移等特征,以及患者年龄等相关因素中,只有VI区淋巴结对前上纵隔淋巴结状态有影响;60例患者前上纵隔淋巴结转移率为10/60(16.67%)。相关因素的前上纵隔淋巴结转移率对比:≥55岁vs<55岁(20%vs 16.36%,P<0.05);肿块位于下极vs上极vs中极(P>0.05);最大直径≥1.5 cm vs最大直径<1.5 cm(18.18%vs 15.79,P>0.05);单灶vs多灶(21.88%vs 10.71%,P>0.05);单叶vs多叶(17.5%vs 15%,P>0.05);男性vs女性(20%vs 15.55%,P>0.05);Ⅵ区淋巴结阳性vs阴性(24.43%vs 3.57%,P<0.05);结论总体来说,甲状腺乳头状癌前上纵隔淋巴结转移率较低。本研究发现VI区淋巴结状态可能与前上纵隔淋巴结转移相关,未来仍需大样本前瞻性的研究验证。

Objective To investigate the relationship between clinicopathological features such as the tumor location,maximum diameter,extranodal thyroid invasion,and anterior superior mediastinal lymph node metastasis of thyroid carcinoma.Methods We analyzed the clinical and pathological data of 60 patients with thyroid papillary carcinoma who were admitted to the Head and Neck Surgery Department at Sichuan Cancer Hospital for primary surgery between September 2018 and February 2019.The correlation between the clinical and pathological features and the positive rate of the anterior and upper mediastinal lymph nodes was analyzed using the chi-square test.Results Among the features of tumor location,maximum diameter,number,extranodal invasion,number of involved gland lobes and lymph node metastasis in regionⅥ,as well as the age of patients and other relevant factors,only the lymph nodes in regionⅥaffected the status of anterior superior mediastinal lymph nodes.Ten of the 60 patients(16.67%)had anterior superior mediastinal lymph node metastasis.The rates of anterior superior mediastinal lymph node metastasis were compared among the related factors:age>or equal to 55 years vs.younger than 55 years(20%vs.16.36%;P<0.05);mass located in the lower pole vs.the upper pole vs.the middle pole(P>0.05);maximum diameter greater than or equal to 1.5 cm vs.less than 1.5 cm(18.18%vs.15.79;p>0.05),single focus vs.multiple focus(21.88%vs.10.71%;P>0.05),single vs.multiple leaves(17.5%vs.15%;P>0.05);males vs.females(20%vs.15.55%;P>0.05);positive vs.negative lymph nodes in areaⅥ(24.43%vs.3.57%;P<0.05).Conclusion The rate of anterior and upper mediastinal lymph node metastasis in thyroid papillary carcinoma is relatively low.In this study,it was found that the status of lymph nodes inⅥregion may be related to anterior superior mediastinal lymph node metastasis,and prospective studies with large samples are still needed in the future.