甲状腺微小乳头状癌中央区淋巴结转移的相关因素

Related factors of central lymph node metastasis in papillary thyroid microcarcinoma

目的评估甲状腺微小乳头状癌(PTMC)临床病理特点与中央区淋巴结转移的相关性,以此来筛选出PTMC中央区淋巴结转移的高危因素。方法收集南京鼓楼医院甲状腺外科2014年1月至2016年8月期间收治的308例行预防性中央区淋巴结清扫PTMC患者的临床病理资料,用荧光定量聚合酶链式反应检测308例患者鼠类肉瘤滤过性病毒致癌同源体B1(BRAFV)600E突变情况,回顾性分析其临床病理特点及BRAFV600E突变情况与中央区淋巴结转移的关系。结果单因素分析显示男性、<45岁、肿瘤最大径>0.5 cm、肿瘤多灶性病变、含有砂砾体、有腺叶内播散以及BRAFV600E突变的患者更易发生中央区淋巴结转移(P<0.05),而中央区淋巴结转移情况与甲状腺球蛋白水平、是否合并慢性淋巴细胞性甲状腺炎、是否合并结节性甲状腺肿或腺瘤、肿瘤是否有完整包膜、是否侵犯甲状腺被膜、是否出现甲状腺外浸润、出现脉管、神经浸润等无关(P>0.05)。Logistic回归分析发现,男性、年龄<45岁、肿瘤最大径>0.5 cm、多灶性、含有砂砾体、有腺叶内播散、有BRAFV600E突变是中央区淋巴结转移的危险因素。结论建议对于有中央区淋巴结转移高危因素的患者(如男性、年龄<45岁、肿瘤最大径>0.5 cm、多灶性及砂砾体、有腺叶内播散、BRAFV600E突变)进行预防性中央区淋巴结清扫。

Objective To analyze the associations of the clinical and pathological features with central lymph node metastasis in patients with papillary thyroid microcarcinoma(PTMC)to explore the risk factors of central lymph node metastasis and provide a theoretical basis for the surgical options in PTMC patients.Methods A total of 308 PTMC patients receiving prophylactic central lymph node dissection(CLND)in Nanjing Dram Tower Hospital from January 2014 to August 2016 were selected.Realtime fluorescence quantitative polymerase chain reaction(RT-PCR)was used to detect BRAFV600 E(v-raf murine sarcoma viral oncogene homolog B1)gene mutation,and the associations of clinicopathological features and BRAFV600 E mutation with central lymph node metastasis were analyzed retrospectively.Results The male patients less than 45 years old with larger tumor size(>5 mm),tumor multifocality,psammoma bodies,intraglandular dissemination and BRAFV600 E gene mutation were more likely to have central lymph node metastasis(P<0.05).While the central lymph node metastasis was not significantly associated with thyroglobulin level and whether there were chronic lymphocytic thyroiditis,nodular goiter or adenoma,complete capsule,invasion of thyroid capsule,extrathyroid invasion,vascular invasion and neural invasion(P>0.05).Logistic regression analysis showed that male gender,younger age(<45 years dd),larger tumor size(>5 mm),multifocality,psammoma bodies,intraglandular dissemination and BRAFV600 E gene mutation were the risk factors of central lymph node metastasis in PTMC patient.Conclusion It is suggested that the preventive central lymph node dissection should be performed for the patients with high risk factors of central lymph node metastasis.