多灶甲状腺微小乳头状癌的临床病理特征及中央区淋巴结转移危险因素分析

Clinicopathological Characteristics of Multifocal Papillary Thyroid Microcarcinoma and Analysis of Risk Factors for Central Lymph Node Metastasis

目的探讨多灶甲状腺微小乳头状癌的临床病理特征及中央区淋巴结转移的危险因素,以规范临床治疗方案。方法回顾性分析2018年9月~2021年3月笔者医院甲状腺外科收治的甲状腺微小乳头状癌(PTMC)患者458例的临床资料,分析比较甲状腺乳头状癌单灶及多灶临床病理学的差别,并分析多灶PTMC中央区淋巴结转移的危险因素。结果多灶PTMC患者与单灶PTMC患者在性别、年龄、癌灶最大径及是否合并HT方面比较差异无统计学意义(P>0.05),但多灶PTMC更易发生中央区淋巴结转移(P=0.008)及包膜侵犯(P=0.015);多灶PTMC患者中,癌灶个数≥3个、具有包膜侵犯的患者中央区淋巴结转移率明显高于癌灶个数为2个(P=0.002)、无包膜侵犯的患者(P=0.000);多因素二元Logistic回归分析显示,癌灶个数增加(OR=4.869,95%CI:1.720~13.781,P=0.003)及包膜侵犯(OR=4.869,95%CI:2.596~20.952,P=0.000)为多灶PTMC中央区淋巴结转移的独立危险因素。结论多灶PTMC较单灶PTMC侵袭性更强,更易发生包膜侵犯及中央区淋巴结转移,建议对多灶PTMC患者行甲状腺切除的同时行预防性中央区淋巴结清扫术。

Objective To investigate the clinicopathological characteristics of multifocal papillary thyroid microcarcinoma and the risk factors of central lymph node metastasis,so as to standardize the clinical treatment plan.Methods We retrospectively analyzed the clinical data of 458 patients with papillary thyroid microcarcinoma(PTMC)admitted to our hospital from September 2018 to March 2021,and analyzed and compared the clinical pathology of single and multifocal thyroid papillary carcinoma,and analyzed the risk factors of lymph node metastasis in the central area of multifocal PTMC.Results There was no statistically significant difference between multifocal PTMC patients and single-focal PTMC patients in terms of gender,age,maximum diameter of cancer lesions,and HT(P>0.05),but multifocal PTMC was more prone to central lymph node metastasis(P=0.008))and capsular invasion(P=0.015).In patients with multifocal PTMC,the number of cancer foci≥3 and the rate of lymph node metastasis in the central area of patients with capsular invasion was significantly higher than the number of cancer foci with 2(P=0.002),no envelope Patients with invasion(P=0.000).Multivariate binary Logistic regression analysis showed that the number of cancer foci increased(OR=4.869,95%CI:1.720-13.781,P=0.003)and capsule invasion(OR=4.869,95%CI:2.596-20.952,P=0.000)was an independent risk factor for multifocal PTMC central lymph node metastasis.Conclusion Multifocal PTMC is more aggressive than single-focal PTMC,and it is more prone to envelopment and central lymph node metastasis.It is recommended that patients with multifocal PTMC undergo thyroidectomy and preventive central lymph node dissection.