甲状腺微小乳头状癌淋巴结转移和腺外侵犯的危险因素分析

Risk factors for lymph node metastasis and extra-glandular invasion in thyroid micropapillary carcinoma

目的研究甲状腺微小乳头状癌(PTMC)中央区淋巴结转移(CLNM)及腺外侵犯(ETE)的危险因素。方法回顾性分析2017年5月至2019年12月首次就诊行甲状腺手术的157例PTMC患者资料,所有患者术中均行中央区淋巴结清扫,术后病理明确ETE发生情况。采用SPSS 25.0统计软件进行分析,将与CLNM及ETE相关的临床病理因素进行单因素及logstic多因素回归分析,P<0.05差异有统计学意义。结果157例PTMC患者45例(28.7%)发生CLNM,23例(14.6%)发生ETE。将单因素分析中有意义的因素纳入logstic多因素回归分析,显示:年龄<55岁、男性、BRAFV600E基因突变阳性、肿瘤直径>5 mm、双侧腺叶多灶及被膜侵犯是影响CLNM的独立危险因素(P<0.05);肿瘤直径>5 mm、双侧腺叶多灶是影响ETE的独立危险因素(P<0.05)。结论年龄<55岁、男性、BRAFV600E基因突变阳性、肿瘤直径>5 mm、双侧腺叶多灶及被膜侵犯是影响CLNM的独立危险因素,肿瘤直径>5 mm、双侧腺叶多灶是影响ETE的独立危险因素。

Objective To investigate the risk factors for central lymph node metastasis(CLNM)and extra-glandular invasion(ETE)in minimal papillary thyroid carcinoma(PTMC).Methods Retrospective analysis was performed on the data of 157 patients with PTMC who received thyroid surgery for the first time from May 2017 to December 2019.All patients underwent central lymph node dissection during surgery,and the occurrence of ETE was determined by postoperative pathology.SPSS 25.0 statistical software was used for analysis.Univariate and logstic multivariate regression analysis was performed on the clinicopathological factors related to CLNM and ETE,and the difference was statistically significant at P<0.05.Results CLNM occurred in 45(28.7%)of 157 PTMC patients,and ETE occurred in 23(14.6%)patients.Logstic multivariate regression analysis showed that age<55 years old,male,BRAF V600E gene mutation positive,tumor diameter>5 mm,bilateral multifocal glandular lobes and capsule invasion were independent risk factors for CLNM(P<0.05).Tumor diameter was>5 mm and bilateral glandular lobes were independent risk factors for ETE(P<0.05).Conclusion Age<55 years old,male,positive BRAFV600E gene mutation positive,tumor diameter>5 mm,bilateral glandular leaves and capsule invasion are independent risk factors for CLNM,tumor diameter>5 mm,bilateral multiple foci of glandular leaves are independent risk factors for ETE.