滤泡亚型及经典型甲状腺乳头状癌的临床特征和颈部淋巴结转移的相关因素分析

Clinical Characteristics and Related Factors Analysis of Cervical Lymph Node Metastasis in Classic and Follicular Variant of Papillary Thyroid Carcinoma

目的探讨滤泡亚型甲状腺乳头状癌(FVPTC)及经典型甲状腺乳头状癌(CPTC)的临床特征和颈部淋巴结转移(CLNM)的相关影响因素。方法回顾性分析2013-01—2022-10郑州大学第一附属医院行手术治疗并经术中和术后病理学检查确诊的116例FVPTC患者(FVPTC组)及110例CPTC患者(CPTC组)的临床资料。应用二元Logistic回归模型分析FVPTC及CPTC患者CLNM的独立影响因素。结果FVPTC组的肿瘤直径、彩超分级、BRAF基因突变率、淋巴结转移个数、甲状腺过氧化物酶抗体(TPOAb)、促甲状腺激素受体抗体(TRAB)均低于CPTC组,差异均有统计学意义(P<0.05)。FVPTC组中肿瘤大小和彩超分级是CLNM的独立危险因素,年龄是CLNM的独立保护因素。CPTC组中彩超分级是CLNM的独立危险因素,年龄是CLNM的独立保护因素。结论FVPTC的多项临床特征与CPTC存在差异,可协助鉴别诊断。肿瘤体积大、彩超分级高的年轻患者CLNM可能性较大,应采取更积极的治疗方案。

Objective To explore the clinical characteristics and influencing factors of cervical lymph node metastasis(CLNM)in follicular variant papillary thyroid carcinoma(FVPTC)and classical papillary thyroid carcinoma(CPTC).Methods Retrospective analysis of clinical data of 116 FVPTC patients(FVPTC group)and 110 CPTC patients(CPTC group)who underwent surgical treatment and were confirmed by intraoperative and postoperative pathological examination at the First Affiliated Hospital of Zhengzhou University from January 2013 to October 2022.Apply a binary Logistic regression model to analyze the independent influencing factors of CLNM in FVPTC and CPTC patients.Results The tumor diameter,ultrasound grading,BRAF gene mutation rate,number of lymph node metastases,thyroid peroxidase antibody(TPOAb),and thyroid stimulating hormone receptor antibody(TRAB)in the FVPTC group were all lower than those in the CPTC group,and the differences were statistically significant(P<0.05).Tumor size and ultrasound grade are independent risk factors for CLNM in the FVPTC group,while age is an independent protective factor for CLNM.Ultrasound grading is an independent risk factor for CLNM in the CPTC group,and age is an independent protective factor for CLNM.Conclusion There are multiple clinical features of FVPTC that differ from CPTC,which can assist in differential diagnosis.Young patients with large tumor volume and high ultrasound grading are more likely to have CLNM,and more aggressive treatment plans should be adopted.