甲状腺髓样癌淋巴结转移相关因素及生存分析

Risk Factors of lateral cervical lymph node metastases and survival analysis in patients with medullary thyroid carcinoma

目的研究甲状腺髓样癌(medullary thyroid carcinoma,MTC)淋巴结转移(lymph node metastasis,LNM)的相关因素及生存分析。方法回顾性分析2008年9月至2020年8月北京市解放军总医院第一医学中心普通外科及耳鼻咽喉科经治的93例MTC患者,其中男45例,女48例,中位年龄47岁。对初始手术年份及术式、肿瘤病理分期、术前降钙素(calcitonin,Ctn)水平、术前癌胚抗原(carcinoembryonic antigen,CEA)水平、颈部LNM情况、无复发生存期(recurrence free survival,RFS)等运用SPSS 26.0软件行数据统计分析,采用单、多因素COX回归模型研究影响MTC患者LNM与预后的危险因素,对影响预后的独立危险因素的生存率进行分析并绘制Kaplan-Meier生存曲线。结果93例MTC患者中位随访时间53个月,范围为2~192个月,其在第1、3、5及10年生存率分别为97.8%、96.6%、94.6%和88.9%。多因素COX回归分析得出,初始术式(P=0.018)、术前Ctn(P=0.012)为中央区LNM的独立危险因素,术前Ctn水平(P=0.028)及包膜侵犯(P=0.024)则是侧颈区LNM的独立危险因素。MTC患者术前Ctn水平分别≥180.30 pg/ml及≥234.15 pg/ml时提示出现中央区及侧颈区LNM可能(P值均<0.001)。远处转移是影响MTC患者RFS(P=0.037)的独立危险因素。结论建议对MTC初始治疗采用规范化术式,减少隐匿性转移灶残留可能,降低MTC再次手术风险;远处转移影响着MTC的生存预后。

Objective To investigate the risk factors of cervical lymph node metastasis(LNM)and survival analysis in patients with medullary thyroid carcinoma(MTC).Methods 93 patients with MTC admitted to the Department of General Surgery and Department of Otorhinolaryngology,First Medical Center of PLA General Hospital from Sep.2008 to Aug.2020 were analyzed retrospectively,including 45 males and 48 females,with an average age of 47 years old.SPSS 26.0 statistical software was used for data processing of the initial surgical year and procedures,tumor pathological stages,preoperative calcitonin(Ctn)level,preoperative carcinoembryonic antigen(CEA)level,LNM status,recurrence free survival(RFS),etc.The risk factors of LNM and prognosis of MTC patients were analyzed by COX univariate and multivariate regression.Kaplan Meier method was used to estimate the survival rates of independent risk factors affecting prognosis and draw their survival curves.Results The median follow-up time of 93 patients was 53 months,ranging from 2 to 192 months.The 1-year,3-year,5-year and 10-year survival rates were 97.8%,96.6%,94.6%and 88.9%respectively.Multivariate COX regression analysis showed that Initial surgical procedures(P=0.018)and preoperative Ctn level(P=0.012)were independent risk factors of central cervical LNM.Preoperative Ctn level(P=0.028)and Capsule invasion(P=0.024)were the independent risk factors of lateral cervical LNM.Preoperative Ctn level≥180.30 pg/ml and≥234.15pg/ml indicated central and lateral cervical LNM respectively(all P<0.001).Distant metastasis was an independent risk factor of RFS(P=0.037)of MTC.Conclusions Standardized surgical procedures are recommended for initial treatment of MTC,which can reduce the possibility of residual occult metastasis and the risk of reoperation.Distant metastasis affects prognosis of MTC.