cN0甲状腺微小乳头状癌淋巴结转移的危险因素分析

Risk factors of lymph node metastasis in papillary thyroid microcarcinoma with cN0

目的探讨临床淋巴结转移阴性(cN0)的甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素。方法回顾性收集2013年1月至2018年12月期间重庆医科大学附属第一医院内分泌乳腺外科至少行一侧腺叶切除+中央区淋巴结清扫的cN0 PTMC患者的临床病理资料并分析淋巴结转移的危险因素。结果本研究共纳入1821例cN0 PTMC患者,术后病理结果发现颈部淋巴结转移837例(46.0%),其中中央区淋巴结转移805例(44.2%);761例行颈侧区淋巴结清扫患者中侧区淋巴结转移252例(33.1%)。单因素分析结果显示,男性、年龄<55岁、肿瘤直径≥5 mm、双侧癌、包膜侵犯、多发病灶与cN0 PTMC颈部淋巴结转移有关(P<0.05),进一步对此进行二元logistic回归多因素分析结果发现这些因素(除多发病灶外)是颈部淋巴结转移的独立危险因素(P<0.05);同时发现,随着cN0 PTMC患者中央区淋巴结转移数目增加而发生颈侧区淋巴结转移风险增加(P<0.05)。结论cN0 PTMC患者的颈部淋巴结转移与多种因素有关,且中央区淋巴结转移预示着更高的侧区淋巴结转移风险;对于存在危险因素的患者,首次手术时应给予积极的预防性中央区淋巴结清扫,根据术中情况决定是否行侧区淋巴结清扫。

Objective To investigate the risk factors of cervical lymph node metastasis of papillary thyroid microcarcinoma(PTMC)with clinical lymph node metastasis negative(cN0).Method The clinicopathologic data of patients with cN0 PTMC who underwent at least one lobectomy plus central lymph node dissection in this hospital from January 2013 to December 2018 were retrospectively collected and the risk factors of lymph node metastasis were analyzed.Results A total of 1821 patients with cN0 PTMC were enrolled in this study.The results of postoperative pathology showed there were 837(46.0%)cases with lymph node metastasis,in which of 805(44.2%)cases with central lymph node metastasis;252(33.1%)had lateral lymph node metastasis among 761 patients underwent lateral lymph node dissection.The results of univariate analysis showed that male,age<55 years old,tumor diameter≥5 mm,bilateral cancer,capsule invasion,and multiple foci were associated with lymph node metastasis of cN0 PTMC(P<0.05).Further binary logistic regression multivariate analysis results showed that these factors(except multiple foci)were the independent risk factors of lymph node metastasis of cN0 PTMC(P<0.05).While the results found that the risk of lateral lymph node metastasis was increased with the increasing of the number of central lymph node metastasis in patients with cN0 PTMC(P<0.05).Conclusions Cervical lymph node metastasis of cN0 PTMC is related to many factors,and central lymph node metastasis indicates a higher risk of lateral lymph node metastasis.For patients with risk factors,preventive central lymph node dissection should be given at the first surgery and decided whether to perform lateral lymph node dissection according to the intraoperative situation.