cN0期多灶性分化型甲状腺癌临床分析

Clinical analysis of cN0 multifocal differentiated thyroid carcinoma

目的分析临床分期阴性(cN0)期多灶性分化型甲状腺癌(MDTC)的临床特征及中央区淋巴结转移的独立影响因素。方法选择2020年1月至2021年12月该院肿瘤外科甲乳病区收治的228例cN0期分化型甲状腺癌(DTC)患者资料并进行回顾性分析,依据癌灶数量分为MDTC组(n=78)和单灶性分化型甲状腺癌(SDTC)组(n=150),对比分析两组患者在性别、年龄、癌灶直径、癌灶数量、是否侵犯包膜、中央区淋巴结转移情况、是否伴有桥本甲状腺炎等方面的差异,分析MDTC的临床特征。选择logistic回归分析中央区淋巴结发生转移的影响因素。结果SDTC组与MDTC组在年龄、性别、肿瘤直径方面比较,差异均无统计学意义(P>0.05),但MDTC组更易侵犯甲状腺被膜,发生中央区淋巴结转移、合并桥本甲状腺炎,两者比较,差异有统计学意义(P<0.05)。相对于癌灶数量为2灶的患者,癌灶数量为3灶及以上的患者更易侵犯甲状腺被膜,发生中央区淋巴结转移,两者比较,差异均有统计学意义(P<0.05),而在合并桥本甲状腺炎方面,两者比较,差异无统计学意义(P>0.05)。logistic回归分析显示,侵犯甲状腺被膜与癌灶数量,为颈中央区淋巴结转移的独立影响因素(OR=7.714、0.140,P=0.033、0.007)。结论cN0期MDTC患者具有较强的侵袭性,建议行甲状腺全切术。

Objective To analyze the clinical features of multifocal differentiated thyroid carcinoma(MDTC)with negative clinicalstage(cN0)and the independent influencing factors of centrallymph node metastasis.Methods The data of 228 patients withc N0 differentiated thyroid cancer(DTC)admitted to the Department of Oncology,the First Affiliated Hospital of Bengbu Medical College from January 2020 to December 2021 were retrospectively analyzed.According to the number of cancerfoci,they were divided into MDTC group(n=78)and single-focal differentiated thyroid cancer(SDTC)group(n=150).The clinical features of MDTC were analyzed bycomparing the differences in gender,age,diameter of cancer foci,number of cancer foci,capsuleinvasion,centrallymph nodemetastasis and Hashimoto′sthyroiditis between the two groups.Logistic regression was selected to analyze the influencing factors of central lymph node metastasis.Results There was significant difference in age,gender and tumor diameter between the SDTC group and the MDTC group(P<0.05).However,the MDTC group was more likely to invade the thyroid capsule,develop central lymph node metastasis,and have Hashimoto′s thyroiditis.There was no significant difference between the two groups(P<0.05).Compared with patients with two lesions,patients with three or more lesions were more likely to invade the thyroid capsule and have central lymph node metastasis,and the difference was statistically significant(P<0.05).However,there was no significant differencein Hashimoto′s thyroiditis(P>0.05).Logistic regression analysis showed that the invasion of thyroid capsule and the number of cancer foci w ere independent influencing factors of cervical central lymph node metastasis(OR=7.714,0.140,P=0.033,0.007).Conclusion Patients with cN0 MDTC have stronginvasiveness,and total thyroidectomy is recommended.