峡部甲状腺乳头状癌颈部淋巴结转移的危险因素研究

Risk factors of cervical lymph node metastasis in isthmic papillary thyroid carcinoma

目的通过分析峡部甲状腺乳头状癌(PTC)患者的结节超声特征探讨颈部淋巴结转移的危险因素。方法回顾性分析2014年6月至2017年3月浙江大学医学院附属杭州市第一人民医院手术证实为峡部PTC 86例患者的结节超声特征,根据病理结果有无颈部淋巴结转移分为转移组24例和无转移组62例,比较两组患者的结节超声特征,采用logistic回归分析其与颈部淋巴结转移的相关性,应用ROC曲线分析结节平均内径对峡部PTC诊断的灵敏度和特异度。结果转移组突破甲状腺包膜的颈部淋巴结转移发生率高于无转移组,差异有统计学意义(P<0.01)。logistic回归分析表明,结节平均内径是峡部PTC颈部中央区淋巴结转移的危险因素(OR=0.814,P<0.01)。以结节平均内径预测峡部PTC患者发生颈部中央区淋巴结转移的AUC为0.788,最佳截断值为7.9 mm,灵敏度为80.6%,特异度为75.0%。结论结节平均内径以及甲状腺是否突破背膜是峡部PTC发生颈部淋巴结转移的主要危险因素。

Objective To investigate the risk factors of central cervical lymph node metastasis(CLNM)in patients with isthmus papillary thyroid carcinoma.Methods The clinical data and ultrasonographic findings of 86 patients with isthmus papillary thyroid carcinoma confirmed by pathological examination admitted in the Hangzhou First People's Hospital from June 2014 to March 2017 were retrospectively analyzed.There were 24 cases with cervical lymph node metastasis(CLNM group)and 62 cases without CLNM(non-metastatic group).The correlation of clinical and ultrasound characteristics with cervical lymph node metastasis was analyzed usingχ2 test and multivariate logistic regression.The ROC curve was used to analyze the size of the nodule in the diagnosis of papillary thyroid carcinoma(PTC).Results The nodule size and the penetration of thyroid capsule in CLNM group were higher than those in the non-metastatic group(P<0.01).Multivariate logistic regression analysis showed that the tumor size(OR=0.814,P<0.01)was an independent predictor of lymph node metastasis in the central cervical region of isthmic PTC.The ROC curve showed that the AUC of the nodule size was 0.788,and when the cutoff value was 7.9mm,Sensitivity,Specificity were 80.6%,75.0%,respectively.Conclusion The study suggests that the size of nodules and penetration of the thyroid back membrane are associated with the cervical lymph node metastasis in isthmic papillary thyroid carcinoma.