中央区淋巴结转移强度对甲状腺乳头状癌颈侧区淋巴结转移的临床意义

Predictive effect of central lymph node intensity on lateral lymph node metastasis for papillary thyroid carcinoma

目的应用中央区淋巴结转移(central lymph node metastasis,CLNM)强度概念,探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈侧区淋巴结转移(lymph node metastasis,LNM)危险因素及对其影响。方法回顾性分析内蒙古医科大学附属医院甲状腺乳腺外科2009年1月至2017年4月收治的106例行PTC颈淋巴结清扫术完整临床资料,根据颈侧区淋巴结是否转移分为LNM阳性组(75例)、LNM阴性组(31例)。探讨性别、年龄、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TGAb)、甲状腺过氧化物酶抗体(TPOAb)、是否合并桥本氏甲状腺炎、肿瘤位置、侵犯被膜、多灶性、肿瘤腺体内分布、肿瘤直径、CLNM数目、CLNM率等转移相关危险因素,分析CLNM强度对颈侧区LNM的影响。采用SPSS 21.0软件进行数据分析,正态分布的计量资料以均值±标准差(±s)表示,组间比较采用t检验。计数资料以率(构成比)表示,组间比较采用χ2检验或Fisher确切概率法。结果单因素分析发现,是否合并桥本氏甲状腺炎(P=0.087)、肿瘤位置(P=0.249)、肿瘤腺体内分布(P=0.219)、肿瘤直径(P=0.224)与颈侧区LNM无关,差异无统计学意义(P>0.05);而侵犯被膜(P=0.030)、多灶性(P=0.031)、CLNM数目(P=0.022)、CLNM率(P=0.001)与颈侧区LNM有关,差异有统计学意义(P<0.05)。CLNM数目和CLNM率增加与颈侧区LNM呈正相关;当CLNM数目≥4或(和)CLNM率≥20%时,颈侧区LNM发生率明显增高,差异有统计学意义(P<0.05)。结论侵犯被膜、多灶性是颈侧区LNM的危险因素;当CLNM强度:转移数目≥4枚或(和)转移率≥20%时,建议行颈侧区淋巴结清扫术。

Objective To investigate the risk factors and predictive effect of lateral cervical lymph node metastasis of papillary thyroid carcinoma(PTC)by applying the concept of central lymph node metastasis intensity.Methods This study retrospectively analyzed integrated clinic data of 106 cases with PTC undergoing treatment of cervical lymph node dissection in Department of Thyroid and Breast Surgery of the Affiliated Hospital of Inner Mongolia Medical University from Dec.2009 to Jan.2014.Based on whether lateral cervical lymph nodes had metastasis,patents were classified into lymph node metastasis positive group(n=75 cases),lymph node metastasis negative group(n=31 cases).This study explored metastasis-associated risk factors of age,gender,triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),thyroglobulin antibody(TGAb),thyroid peroxidase antibody(TPOAb),whether combined with Hashimoto's disease,tumor location,infringing the membrane,mulifocality,tumor glands distribution,tumor diameter,number of central lymph node metastases,central lymph node metastasis ratio,and analyzed the effects of central lymph node metastasis intensity on lateral cervical lymph node metastasis.SPSS 21.0 software was used for data analysis,the metering data of normal distribution was expressed as x±s,and t test was used for comparison between groups.Count data was expressed as a rate(composition ratio),and comparisons between groups were performed by x^(2) test or Fisher exact probability method.Results Univariate analysis found that whether combined with Hashimoto's disease(P=0.087),tumor location(P=0.249),tumor glands distribution(P=0.219)and tumor diameter(P=0.224)had no correlation with lateral cervical lymph node metastasis,which showed no statistical significant differences(P>0.05).Infringing the membrane(P=0.030),mulifocality(P=0.031),number of central lymph node metastases(P=0.022)and central lymph node metastasis ratio(P=0.001)had correlation with lateral cervical lymph node metastasis,which showed statistical significant differences(P<0.05).The number of central lymph node metastases and the increase of central lymph node metastasis ratio had positive correlation with the occurrence of lateral cervical lymph node metastasis;when the number of central lymph node metastases was or(and)the central lymph node metastasis ratio was M20%,the incidence of lateral cervical lymph node metastases increased significantly,and the difference was statistically significant(P<0.05).Conclusion Infringing the membrane and mulifocality are risk factors for lateral cervical lymph node metastasis.When central lymph node metastasis intensity:number of metastases M4 or(and)metastasis ratio M20%,lateral cervical lymph node dissection is recommended.