甲状腺微小乳头状癌颈部淋巴结转移的高危因素分析

High-Risk Factors for Cervical Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

目的 分析cT1aN0期甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的高危因素。方法 回顾性研究医院2019年1月至2020年11月收治的188例PTMC患者的临床资料,患者接受全甲状腺切除或甲状腺腺叶切除加颈部淋巴结清扫。通过单因素及多因素回归分析PTMC颈淋巴结转移的高危因素。结果 单因素分析显示,肿瘤累及包膜、单灶肿瘤直径>5 mm与PTMC患者同侧Ⅵ区淋巴结转移有关(P<0.05)。多因素分析结果显示肿瘤累及包膜、单灶肿瘤直径>5 mm、男性患者是PTMC同侧Ⅵ区淋巴结转移独立的高危因素(P<0.05)。单因素分析显示,对侧中央区淋巴结阳性和阴性患者的性别、年龄、病灶分类、肿瘤位置、肿瘤直径、肿瘤累及包膜、同侧颈部Ⅵ区淋巴结转移与对侧Ⅵ区淋巴结转等比较,差异无统计学意义(P>0.05)。单因素分析显示,肿瘤位于甲状腺上极、同侧Ⅵ区淋巴结转移与同侧侧颈淋巴结转移相关(P<0.05)。多因素分析结果显示肿瘤位于甲状腺上极、同侧Ⅵ区淋巴结转移是PTMC同侧侧颈淋巴结转移独立的高危因素(P<0.05)。结论 单灶肿瘤直径>5 mm、肿瘤累及包膜、男性PTMC患者更易发生同侧中央区淋巴结转移。肿瘤位于甲状腺上极和同侧中央区淋巴结阳性患者更易发生侧颈淋巴结转移。

Objective To analyze the high risk factors of cervical lymph node metastasis in stage cT 1a N 0 papillary thyroid micro carcinoma(PTMC).Methods The clinical data of 188 PTMC patients admitted to hospital from January 2019 to November 2020 were retrospectively studied.The patients received total thyroidectomy or thyroid lobectomy plus neck lymph node dissection.The high risk factors of cervical lymph node metastasis of PTMC were analyzed by univariate and multivariate regression.Results Univariate analysis showed that tumor involving capsule and single focus tumor diameter>5 mm were related to ipsilateral lymph node metastasis in PTMC patients(P<0.05).Multivariate analysis showed that the tumor involved the capsule,the diameter of single tumor was more than>5 mm,and male patients were independent risk factors for lymph node metastasis in ipsilateral PTMC(P<0.05).Univariate analysis showed that there was no statistical difference in gender,age,lesion classification,tumor location,tumor diameter,tumor involved capsule,lymph node metastasis in ipsilateral cervical region and lymph node metastasis in contralateral central region(P>0.05).Univariate analysis showed that lymph node metastasis in the upper pole of thyroid gland and ipsilateralⅥregion was related to ipsilateral cervical lymph node metastasis(P<0.05).Multivariate analysis showed that lymph node metastasis in the upper pole of thyroid gland and ipsilateralⅥregion was an independent risk factor for ipsilateral cervical lymph node metastasis in PTMC(P<0.05).Conclusion Male PTMC patients with single focus tumor diameter>5 mm,tumor involving capsule,are more likely to have ipsilateral central lymph node metastasis.Patients with positive lymph nodes located in the upper pole of thyroid gland and ipsilateral central area are more likely to have lateral cervical lymph node metastasis.