甲状腺乳头状癌合并桥本甲状腺炎患侧中央区淋巴结转移的临床危险因素分析

Risk factors of central lymph node metastasis in papillary thyroid cancer complicated with Hashimoto's thyroiditis

目的探讨甲状腺乳头状癌(PTC)合并桥本甲状腺炎(HT)患者患侧中央区淋巴结转移(CLNM)的危险因素,并建立数学模型评估危险因素的预测价值。方法回顾2016年1月至2019年1月浙江大学医学院附属杭州市第一人民医院收治的173例PTC合并HT患者临床资料,采用单因素、多因素分析患者发生患侧CLNM的危险因素,并采用logistic回归分析建立数学模型评估其预测价值。结果173例PTC合并HT患者共211侧中央区淋巴结纳入研究,患侧CLNM 71侧,转移比例33.65%。单因素分析结果显示,患者年龄、患侧病灶数目、患侧病灶最大径、被膜侵犯和患侧侧颈淋巴结转移与患侧CLNM密切相关(均P<0.05)。多因素分析结果显示,患者年龄<38岁、患侧病灶数目多发、患侧病灶最大径>5 mm和患侧侧颈淋巴结转移是患侧CLNM的独立危险因素(均P<0.05),这4个临床特征构建的数学模型(Y=-1.872+0.841×患者年龄+0.863×患侧病灶数目+0.756×患侧病灶最大径+1.892×患侧侧颈淋巴结转移)对预测PTC合并HT患者患侧CLNM的AUC为0.713,预测的灵敏度为0.6338,特异度为0.7571。结论年龄<38岁、患侧多发病灶、患侧病灶最大径>5 mm和患侧侧颈淋巴结转移是PTC合并HT患者患侧CLNM的独立危险因素。

Objective To investigate the risk factors of central lymph node metastasis(CLNM)in papillary thyroid carcinoma(PTC)complicated with Hashimoto's thyroiditis(HT).Methods Clinicopathologic data of 173 PTC patients complicated with HT admitted in Hangzhou First People's Hospital from January 2016 to January 2019 were retrospectively analyzed.The risk factors of CLNM were analyzed by univariate and multivariate analysis,and a mathematical model was established to predictive the CLNM.Results A total of 211 ipsilateral central lymph nodes in 173 PTC patients with HT were analized with a CLNM rate of 33.65%.The univariate analysis showed that the ipsilateral CLNM was related to the age,number of lesions,maximum diameter of lesions,capsule invasion and ipsilateral lateral lymph node metastasis(all P<0.05).The multivariate Logistic regression revealed that age<38,number of lesions,maximum diameter of lesions>5 mm and ipsilateral lateral lymph node metastasis were independent predictors of ipsilateral CLNM.The area under ROC curve(AUC)of the mathematical model(Y=-1.872+0.841×age+0.863×number of lesions+0.756×maximum diameter of lesions+1.892×ipsilateral lateral cervical lymph node metastasis)for predicting CLNM was 0.713,and the sensitivity and specificity was 63.38%and 75.71%,respectively.Conclusion The age<38,multifocal lesions,diameter of lesions>5 mm and lateral lymph node metastasis are independent predictors of ipsilateral CLNM in PTC patients complicated with Hashimoto's thyroiditis.