甲状腺微小乳头状癌中沙粒体与临床病理特征的相关性分析

Relationship between the psammoma bodies and clinicopathological features in papillary thyroid microcarcinoma

目的 探讨甲状腺微小乳头状癌(PTMC)中沙粒体(PB)与临床病理特征的相互关系,为外科手术方式的选择提供有价值的参考。方法 回顾性分析2019年1月—6月江苏省原子医学研究所附属江原医院病理科377例具备完整临床病理资料的PTMC患者,采用ROC曲线、集群箱线图、单因素χ^(2)分析及二元logistics多因素回归分析方法研究PB与PTMC临床病理特征的相互关系。结果 ROC曲线显示,通过年龄和肿瘤总直径(TTD)预测PB的最优临界值为44岁和0.6 mm,单因素χ^(2)分析显示年龄<44岁(χ^(2)=21.220,P<0.001)、TTD≥0.6 cm(χ^(2)=6.549,P=0.01<0.05)、多灶(χ^(2)=6.643,P=0.01<0.05)、中央区淋巴结转移(CLNM)(χ^(2)=88.622,P<0.001)的患者PB阳性率更高;多因素logistics回归分析显示年龄<44岁、CLNM是PB发生的独立危险因素(P<0.05);集群箱线图显示伴有PB并发CLNM的PTMC患者趋向年轻化。结论 PTMC患者的PB与年龄和CLNM密切相关,年龄<44岁的PTMC患者更易发生PB,而有PB的PTMC患者CLNM更高。因此,推荐年龄<44岁且存在PB的患者行中央区淋巴结清扫。

Purpose To investigate the relationship between the clinicopathological characteristics and psammoma bodies(PB) in papillary thyroid microcarcinoma(PTMC),which can provide valuable references for the choice of surgical operation. Methods Retrospective analysis of 377 PTMC patients with complete clinical pathological data from January to June 2019 was carried out. The relationship between the PB in tumor and clinicopathological characteristics were studied by ROC curve, clustered boxplot, Chi-square test and binary logistic regression analysis. Results ROC curves showed that the optimal cutoff values of the PB by age and the total tumor diameter(TTD) were 44 years and 0.6 mm. The positive rate of PB patients with age <44 years(χ^(2)=21.220, P<0.001), TTD ≥0.6 cm(χ^(2)=6.549, P=0.01<0.05), multiple-foci(χ^(2)=6.643, P=0.01<0.05) and central lymph node metastasis(CLNM)(χ^(2)=88.622, P<0.001) were higher by Chi-square test. Binary regression analysis showed that the age <44 years and CLNM were independent risk factors of PB(P<0.05). The PTMC patients with PB and CLNM tended to be younger. Conclusion PB is closely related to age and CLNM in patients with PTMC. The PTMC patients under 44 years old are more likely to have PB, while CLNM rates of the PTMC patients with PB are higher. Central lymph node dissection is recommended for PTMC patients under 44 years old and having PB.