经典型甲状腺癌跳跃性转移的危险因素分析

Risk factors of skip metastasis in conventional papillary thyroid carcinoma

目的探讨经典型甲状腺乳头状癌(CPTC)跳跃性转移的影响因素,以助外科医师在面对中央区淋巴结阴性的N1b期患者时制定正确的治疗策略。方法共纳入302例接受双侧中央区淋巴结清扫+单侧或双侧改良根治性颈清扫术并被诊断为侧颈区淋巴结转移的CPTC患者。收集其临床及病理资料,并通过单因素和多因素分析探讨它们与跳跃性转移的相关性。结果 302例CPTC跳跃性转移的发生率为10.6%,年龄(OR=5.775,95%CI 2.482~13.437,P <0.001)、合并桥本甲状腺炎(OR=3.470,95%CI 1.274~9.452,P=0.015)和腺外侵犯(OR=2.397,95%CI 1.060~5.421,P=0.036)是CPTC跳跃性转移的独立影响因素。结论 CPTC跳跃性转移与年龄、合并桥本甲状腺炎及甲状腺肿瘤腺外侵犯相关。

Objective To identify the risk factors of skip metastasis in conventional papillary thyroid carcinoma(CPTC), aiming to assist the surgeons to determine a correct treatment for N1 b-stage CPTC patients with negative central lymph nodes. Method A total of 302 CPTC patients who underwent bilateral central lymph node dissection + unilateral or bilateral modified radical cervical dissection and were diagnosed with lateral cervical lymph node metastasis were recruited in this study. Clinicopathological data were collected. The correlation between clinicopathological data and skip metastasis was investigated by univariate and multivariate analyses. Results The incidence of CPTC skip metastasis was 10.6%. Age(OR = 5.775, 95% CI 2.482 ~13.437, P < 0.001), complicated with Hashimoto’s thyroiditis(OR = 3.470, 95% CI 1.274 ~ 9.452, P =0.015) and extrathyroidal invasion(OR = 2.397, 95% CI 1.060 ~ 5.421, P = 0.036) were the independent risk factors of CPTC skip metastasis. Conclusion Skip metastasis of CPTC is significantly associated with age, complicated with Hashimoto’s thyroiditis and extrathyroidal invasion.