甲状腺乳头状癌侧颈部淋巴结跳跃转移特征及影响因素分析

Analysis of characteristics and influencing factors of cervical lymph node skip metastasis in papillary thyroid carcinoma

目的分析伴有侧颈部淋巴结跳跃转移的甲状腺乳头状癌患者临床病理特征,探讨跳跃转移的相关影响因素,指导侧区精准治疗。方法采用回顾性病例对照研究的方法分析2014年2月—2022年3月首都医科大学宣武医院初诊收治的237例甲状腺乳头状癌伴有侧区淋巴结转移患者的临床病理资料,其中中央区淋巴结阳性217例,阴性20例,跳跃转移比例8.4%。比较跳跃转移与非跳跃转移患者的年龄、性别、病理类型、累及腺叶情况、肿瘤大小、肿瘤灶数、原发灶位置、包膜侵犯情况。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用t检验;非正态分布的计量资料以M(Q_(1),Q_(3))来表示,组间比较采用Mann-Whitney U检验。计数资料以例(%)表示,组间比较采用χ^(2)检验、校正χ^(2)检验或Fisher确切概率法。影响因素分析采用单因素分析和多元回归分析。结果多因素分析发现患者年龄≥55岁(OR:6.032,95%CI:1.692~21.504,P=0.006)、女性(OR:23.459,95%CI:2.181~252.341,P=0.009)、肿瘤≤5 mm(OR:79.453,95%CI:7.570~833.891,P<0.001)及原发灶位于上极(OR:3.446,95%CI:1.325~8.962,P=0.011)是颈部淋巴结发生跳跃转移的独立影响因素。与非跳跃转移患者相比,跳跃转移患者清扫淋巴总数较少(Z=-2.81,P=0.005),转移淋巴结总数较少(Z=-6.62,P<0.001),Ⅳ区淋巴结转移数目较少(Z=-2.54,P=0.011)。结论年龄≥55岁、女性、肿瘤直径≤5 mm,肿瘤位于甲状腺上极容易出现颈部淋巴结跳跃转移,对于此类患者需加强颈部侧区评估。

Objective To analyze the characteristics and influencing factors of the patients with cervical lymph node skip metastasis of papillary thyroid carcinoma(PTC),as to guide the precise treatment of lateral area.Methods The clinicopathological data of 237 patients with PTC initially diagnosed and treated in Xuanwu Hospital Capital Medical University from Feb 2014 to Mar 2022 were analyzed retrospectively.Among them,there were 217 positive in the central area,and 20 negative,with skip rate 8.4%.The age,sex,pathological type,glandular lobe involvement,tumor size,number of tumor lesions,primary lesion location,and capsule invasion were statistically compared.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.The measurement data of non normal distribution are expressed by M(Q_(1),Q_(3)),and the Mann Whitney U test is used for comparison between groups.Comparison between groups of count data was conducted using the chi-square test,correction chi-square or Fisher exact probability.Results Multivariate analysis showed that age≥55 years old(OR:6.032,95%CI:1.692-21.504,P=0.006),female(OR:23.459,95%CI:2.181-252.341,P=0.009),tumor≤5 mm(OR:79.453,95%CI:7.570-833.891,P<0.001)and located in the upper lobe(OR:3.446,95%CI:1.325-8.962,P=0.011)were independent risk factors for skip metastasis.The patients with skip metastasis had a smaller total number of cervical lymph node metastases(Z=-2.81,P=0.005),smaller total number of neck dissection lymph nodes(Z=-6.62,P<0.001)and less lymph nodes metastases in levelⅣ(Z=-2.54,P=0.011)than patients with non-skip metastasis.Conclusions Skip metastasis often occurred with age≥55 years,female,tumor size less than 5mm and located in the upper lobe.For these patients,careful evaluation for the lateral area is required.