甲状腺乳头状微小癌cN0期中央区淋巴结转移相关因素分析

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

目的探讨甲状腺恶性肿瘤中cN0期乳头状微小癌(papillary thyroid micro-carcinoma,PTMC)患者出现颈部VI区(中央区)淋巴结发生转移的风险因素,进而决定是否行预防性中央区淋巴结清扫术。方法回顾性分析宁波市第一医院甲乳外科2013年1月至2015年12月收治的500例cN0期PTMC患者资料。根据术后病理结果分为中央区淋巴结转移(central lymph node metastasis,CLNM)(阳性)组和中央区淋巴结未转移((non central lymph node metastasis,Non-CLNM)(阴性)组,运用SPSS 18.0进行单因素分析及多因素分析。结果500例cN0期PTMC中,CLNM为142例。性别、肿瘤最大径、是否腺外侵犯、边界、有无钙化、肿瘤单发或多发、纵横比、有无血流是cN0期PTMC患者发生CLNM的风险因素(P值均<0.05)。多因素分析结果显示,男性(P=0.014)、肿瘤最大径≥0.5 cm(P=0.03)、肿瘤腺外侵犯(P=0.003)、边界不清(P=0.032)、有钙化灶(P=0.009)、纵横比≥1(P=0.001)是中央区淋巴结清扫独立预测因素。结论对于男性患者、肿瘤边界存在不清,肿瘤大小≥0.5 cm、肿瘤生长存在侵犯突破腺体、肿瘤病灶中合并有钙化灶存在、肿瘤病灶垂直生长(纵横比≥1)的cN0期PTMC患者行预防性中央区淋巴结清扫具有临床指导意义。

Objective To investigate the risk factors of lymph node metastasis in the cervical region VI(central region)in patients with papillary thyroid microcarcinoma(PTMC)of cN0 stage,and then to determine whether to perform prophylactic central lymph node dissection.Methods The clinical data of 500 patients with PTMC who underwent surgery from Jan.2013 to Dec.2015 in Ningbo First Hospital were retrospectively analyzed.Due to the pathological results,all patients were divided into two groups:central lymph node metastasis(CLNM)positive group and CLNM negative group.SPSS18.0 was used for analyzing.Results Of the 500 cases of PTMC of cN0 stage,142 cases had lymph node metastasis.Gender,the maximum tumor diameter,tumor invasion outside the gland,boundary,calcification in tumor,single or multiple lesions,aspect ratio and blood flow were risk factors for CLNM in patients with PTMC of cN0 stage.Multivariate analysis identified that male(P=0.014),tumor size≥0.5 cm(P=0.03),tumor invasion outside the gland(P=0.003),unclear boundary(P=0.032),calcification(P=0.009),aspect ratio≥1(P=0.001)were independent predictors factors for CLNM of PTMC.Conclusion Male,unclear boundary,tumor size≥0.5cm,tumor invasion outside the gland,calcification,aspect ratio≥1 are the risk factors of CLNM in patients with cN0 PTMC.Prophylactic central lymph node dissection should be performed for patients without lymph node metastasis but with one risk factor or more.