cN0期峡部甲状腺乳头状癌中央区淋巴结转移的危险因素及预防性清扫的临床分析

Clinical analysis of risk factors and preventive dissection of lymph node metastasis in central region of stage cN0 isthmus papillary thyroid carcinoma

目的探讨影响cN0期峡部甲状腺乳头状癌中央区淋巴结转移的危险因素及预防性清扫的意义及可行性,为临床治疗提供参考。方法回顾性分析2014年1月—2021年12月在连云港市东方医院普外科接受手术的108例cN0期峡部甲状腺乳头状癌患者的临床资料,其中男性32例,女性76例,年龄24~70岁,平均(46.0±12.7)岁。使用SPSS 22.0软件进行统计分析,采用χ^(2)检验及Logistic回归分析中央区淋巴结转移与患者临床病理因素的关系,探讨预防性清扫的可行性。结果峡部甲状腺乳头状癌中央区淋巴结转移阳性率为37.9%(41/108)。单因素分析中央区淋巴结转移与肿瘤直径(χ^(2)=5.36,P=0.021)、包膜浸润(χ^(2)=7.69,P=0.006)、甲状腺球蛋白升高(χ^(2)=7.73,P=0.005)有关,通过多变量分析包膜浸润(HR=2.75,P=0.037)、肿瘤直径(HR=4.45,P=0.004)是中央区淋巴结转移的独立危险因素。绘制肿瘤直径预测中央区淋巴结转移的ROC曲线,计算曲线下面积AUC值为0.720。当直径为0.695 cm时,Youden指数最大为0.326,灵敏度为0.878,特异度为0.448。6例(5.56%)出现临时性喉返神经麻痹,13例(12.04%)出现临时性甲状旁腺功能低下,无永久性并发症发生。结论cN0期PTCI存在早期隐匿性淋巴结转移的风险,预防性CLND可以明确肿瘤的分期并评估危险度,指导患者后续治疗。对于肿瘤内径>0.695 cm、有包膜浸润的患者应常规行CLND。

Objective To explore the risk factors affecting central lymph node metastasis in cN0 isthmus papillary thyroid carcinoma and the significance and feasibility of preventive dissection,so as to provide reference for clinical treatment.Methods The clinical data of 108 patients with cN0 stage isthmus papillary thyroid cancer who underwent surgery in the General Surgery Department of Lianyungang Oriental Hospital from January 2014 to December 2021 were retrospectively analyzed.There were 32 males and 76 females,with an age range of 24 to 70 years,with a mean age of(46.0±12.7)years.Statistical analysis was performed using the SPSS 22.0 statistical software.Chi-square test and logistic regression were used to analyze the relationship between central lymph node metastasis and patients Relationship between clinical case factors.Explore the feasibility of preventive cleaning.Results The positive rate of lymph node metastasis in central region of isthmic papillary thyroid carcinoma was 37.9%(41/108).Univariate analysis showed that central lymph node metastasis was associated with tumor diameter(χ^(2)=5.36,P=0.021),capsular infiltration(χ^(2)=7.69,P=0.006),and elevated thyroglobulin(χ^(2)=7.73,P=0.005).Multivariate analysis showed that capsular infiltration(HR=2.75,P=0.037)and tumor diameter(HR=4.454,P=0.004)were independent risk factors for central lymph node metastasis.The ROC curve of tumor diameter to predict central lymph node metastasis was drawn,and the AUC value of the area under the curve was calculated to be 0.720.When the diameter was 0.695 cm,the Youden index was 0.326,the sensitivity was 0.878,and the specificity was 0.448.6 cases(5.56%)had temporary recurrent laryngeal nerve palsy,13 cases(12.04%)had temporary hypoparathyroidism,no permanent complications occurred.Conclusions cN0 stage PTCI has the risk of early occult lymph node metastasis.Prophylactic CLND can clarify the stage of the tumor,assess the risk,and guide the follow-up treatment of patients.CLND should be routinely performed for patients with tumor diameter>0.695 cm and capsular invasion.