单灶性甲状腺乳头状癌中央区淋巴结转移的影响因素及其临床预测价值

Analysis of influencing factor of central lymph node metastasis in unifocal papillary thyroid carcinoma and its clinical predictive value

目的分析单灶性甲状腺乳头状癌(PTC)发生中央区淋巴结转移(CLNM)的影响因素,探讨其临床预测价值。方法选取我院经手术病理证实的290例单灶性PTC,根据有无CLNM分为转移组114例和无转移组176例,均行常规超声和超声造影检查,比较两组临床资料及超声指标的差异。应用多因素Logistic回归分析筛选单灶性PTC患者CLNM的独立影响因素;绘制受试者工作特征(ROC)曲线评估各独立影响因素联合应用预测单灶性PTC患者CLNM的诊断效能。结果转移组与无转移组在性别、年龄、是否合并桥本甲状腺炎(HT)、结节最大径、成分、回声均匀性、纵横比、微钙化、结节周围甲状腺被膜连续性、增强程度、增强均匀性等方面比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,男性、年龄<35岁、结节最大径≥1.0 cm、微钙化、结节周围甲状腺被膜中断均为单灶性PTC患者CLNM的独立危险因素,HT为CLNM的独立保护因素(均P<0.05)。ROC曲线分析显示,各独立影响因素联合应用预测单灶性PTC患者CLNM的曲线下面积为0.864(95%可信区间:0.823~0.906),灵敏度为86.0%、特异度为76.1%。结论男性、年龄<35岁、结节最大径≥1.0 cm、微钙化、结节周围甲状腺被膜中断、HT均为单灶性PTC患者CLNM的独立影响因素,其联合应用具有重要临床预测价值。

Objective To analyze the influencing factors of the central lymph node metastasis(CLNM)in unifocal papillary thyroid carcinoma(PTC),and to explore its clinical predictive value.Methods A total of 290 cases of unifocal PTC confirmed by surgery and pathology in our hospital were selected.All cases were divided into the metastatic group(114 cases)and non-metastatic group(176 cases)according to the presence or absence of CLNM.Conventional ultrasound and contrastenhanced ultrasound were performed,the differences of clinical data and ultrasound indexes between the two groups were compared.Multivariate Logistic regression analysis was used to screen for independent influencing factors of CLNM in patients with unifocal PTC.Receiver operating characteristic(ROC)curve was drawn to assess the efficacy of combined application of independent influencing factors in predicting CLNM in patients with unifocal PTC.Results There were significant differences between the metastatic group and the non-metastatic group in terms of gender,age,Hashimoto’s thyroiditis(HT),maximum diameter of nodule,composition,echo homogeneity,aspect ratio,microcalcification,perinodular thyroid perineural continuity,enhancement degree and enhancement uniformity(all P<0.05).Multivariate Logistic regression analysis showed that male,age<35 years,maximum diameter of nodule≥1.0 cm,microcalcification,and interruption of the perinodular thyroid peritoneum were independent risk factors for CLNM in patients with unifocal PTC,while HT was an independent protective factor for CLNM(all P<0.05).ROC curve analysis showed that the combined application of all independent influencing factors for predicting CLNM in patients with unifocal PTC with an area under the curve of 0.864(95%confidence interval:0.823~0.906),sensitivity of 86.0%and specificity of 76.1%.Conclusion Male,age<35 years,maximum diameter of nodule≥1.0 cm,microcalcification,interruption of the perinodular thyroid peritoneum,and HT were all independent influencing factors of CLNM in patients with unifocal PTC,and their combined application has important clinical predictive value.