cN0甲状腺微小乳头状癌中央区淋巴结转移数目>5枚危险因素分析

Risk factors for central lymph nodes more than 5 involved in papillary thyroid microcarcinoma with cN0

目的探讨临床淋巴结阴性(clinical lymph node negative,cN0)甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)中央区淋巴结转移(central lymph node metastasis,CLNM)数目>5枚的危险因素。方法回顾性分析2013年1月至2018年12月重庆医科大学附属第一医院内分泌乳腺外科接受手术治疗的单侧cN0 PMTC患者1567例,男405例,女1162例。根据患侧CLNM分为0~5枚组和>5枚组并通过非参数检验、χ^(2)检验等比较两组性别、年龄等临床病理学特征。结果本研究患者CLNM>5枚为4.1%(65/1567)。单因素分析显示男、年龄≤50岁、肿瘤直径>8 mm、多灶癌与cN0 PTMC CLNM>5枚相关(P<0.05);多因素Logistic回归分析显示男(OR=1.886,P=0.017)、年龄≤50岁(OR=3.778,P=0.002)、肿瘤直径>8 mm(OR=2.483,P<0.001)、多灶癌(OR=2.362,P=0.005)为CLNM>5枚的独立危险因素。亚组分析显示喉前淋巴结转移≥1枚(OR=13.475,P<0.001)、气管前淋巴结转移≥2枚(OR=41.695,P<0.001)、喉前+气管前淋巴结转移≥2枚(OR=28.750,P<0.001)为CLNM>5枚的独立危险因素。结论单侧cN0 PTMC患者的CLNM>5枚与多种因素有关,男性、年龄≤50岁且存在肿瘤直径>8 mm、多灶癌的患者出现较多数量淋巴结转移风险增加,此类患者不建议长期随访观察,应积极手术治疗且行预防性中央区淋巴结清扫,并结合术中情况必要时选择全甲状腺切除。

Objective To analyze the risk factors of the number of central lymph node metastasis(CLNM)>5 in papillary thyroid microcarcinoma(PTMC)with clinical lymph node negative(cN0).Methods A total of 1567 cases of unilateral cN0 PTMC patients undergoing surgery at Endocrine and Breast Surgery Department of the First Affiliated Hospital of Chongqing Medical University from Jan.2013 to Dec.2018 were analyzed retrospectively.There were 405 cases of male and 1162 cases of female among them.According to the CLNM,they were divided into 0-5 and≥5 groups.Clinicopathological characteristics of two groups were compared with Chi-square test andχ^(2) test,et al.Results The case of CLNM>5 involved was 4.1%(65/1567).Univariate analysis showed that male,age≤50 years old,tumor diameter>8 mm,multifocal cancer all were related to CLNM>5 involved(P<0.05),multivariate logistic regression analysis found that male(OR=1.886,P=0.017),age≤50 years(OR=3.778,P=0.002),tumor diameter>8 mm(OR=2.483,P<0.001)and multifocal cancer(OR=2.362,P=0.005)were independent risk factors for CLNM>5.Subgroup analysis showed that the number of Delphian lymph nodes metastasis≥1(OR=13.475,P<0.001),pretracheal lymph nodes metastasis≥2(OR=41.695,P<0.001),and Delphian+pretracheal lymph nodes metastasis≥2(OR=28.750,P<0.001)were also independent risk factors for CLNM>5.Conclusions Unilateral PTMC patients who are male and age≤50 years old with tumor diameter>8 mm,multifocal cancer have higher risk of central lymph nodes more than 5 involved,surgical treatment and prophylactic central neck dissection are recommended to such patients instead of long-term follow-up observation.Total thyroidectomy should be selected appropriately according to the intraoperative situation.