甲状腺微小乳头状癌复发危险因素的网状Meta分析

Network Meta-analysis on risk factors of recurrence of papillary thyroid microcarcinoma

目的:探讨甲状腺微小乳头状癌(PTMC)复发的危险因素,为PTMC的个体化诊断和治疗提供参考。方法:检索PubMed、EMBase、Elsevier Science Direct和Web of Science数据库,检索时限为建库至2022年4月,收集与PTMC复发有关的病例对照研究。采用Review Manager 5.4软件进行Meta分析,ADDIS.1.16.8软件进行贝叶斯网状Meta分析,筛选影响PTMC复发的危险因素并排序。结果:纳入14项研究,共7834例PTMC患者接受手术治疗,302例患者出现淋巴结复发、局部甲状腺床复发或远处转移复发。患者的年龄、多灶性、肿瘤大小、腺外侵犯、淋巴结转移和血管侵犯与PTMC复发有相关关系(P<0.05)。淋巴结转移是PTMC复发最大的危险因素,其次为血管侵犯,多灶性为PTMC复发最小的危险因素。性别、病灶组织学背景、腺体组织学背景、放射性碘治疗、手术切缘及甲状腺切除范围与PTMC复发无明显相关性(P>0.05)。结论:淋巴结转移、血管侵犯、肿瘤大小>5 mm、年龄、腺外侵犯和多灶性为PTMC复发的危险因素。临床医生可以考虑给予PTMC患者常规的中心区淋巴结清扫术防止疾病复发,并根据危险因素分层制订个体化治疗方案。

Objective:To discuss the risk factors of recurrence of papillary thyroid microcarcinoma(PTMC),and to provide the reference for the individualized diagnosis and treatment of PTMC.Methods:The retrieval time was limited from the establishment to April 2022,and the case-control studies related to PTMC recurrence searched in PubMed,EMBase,Elsevier Science Direct and Web of Science Databases were collected.Review Manager 5.4 software was used to perform the Meta-analysis and ADDIS 1.16.8 software was used to make the Bayesian network Meta-analysis,and the risk factors of PTMC recurrence were screened out and ranked.Results:Fourteen studies were included,involving 7 834 PTMC patients who underwent surgical treatment,302 patients experienced lymphnode recurrence,local thyroid bed recurrence, or distant metastasis recurrence. Age, multifocality, tumor size,extrathyroidal invasion, lymphnode metastasis, and vascular invasion of the patients were related to thePTMC recurrence (P<0. 05). Lymphnode metastasis was the most significant risk factor for the PTMCrecurrence, followed by vascular invasion, and multifocality was the least significant risk factor. Therewere no significant correlations between gender, lesion histopathological background, glandhistopathological background, radioactive iodine treatment, surgical margin, and the extent ofthyroidectomy with PTMC recurrence (P>0. 05). Conclusion:Lymphnode metastasis, vascularinvasion, tumor size>5 mm, age, extrathyroidal invasion, and multifocality are the risk factors for thePTMC recurrence. The clinician may consider to treat the PTMC patients with routine central lymphnodedissection to prevent disease recurrence, and develop the individualized treatment plans based on the riskfactor stratification.