甲状腺微小乳头状癌颈侧区淋巴结转移临床病理与危险因素分析

Clinicopathological features and risk factors of lateral lymph node metastasis in thyroid micropapillary carcinoma

目的 探讨甲状腺微小乳头状癌的临床病理特征及颈侧区淋巴结转移的危险因素。方法 回顾性分析2018年1月至2020年12月南京医科大学第一附属医院收治的195例甲状腺微小乳头状癌并行颈侧区淋巴结清扫患者的临床病理资料。依据术后颈侧区淋巴结病理结果分为转移组和未转移组。单因素分析两组患者临床病理特征;二分类Logistic回归分析颈侧区淋巴结转移的独立危险因素。结果 195例甲状腺微小乳头状癌患者中央区和颈侧区淋巴结转移率分别为68.2%和66.7%,单因素分析提示颈侧区淋巴结转移组在患者的年龄、肿瘤直径、腺外侵犯及中央区淋巴结转移等方面与未转移组相比差异具有统计学意义(P<0.05);多因素分析提示患者年龄≤45岁(P=0.041),肿瘤直径>5 mm(P=0.014),中央区淋巴结转移(P<0.001)是颈侧区淋巴结转移的独立危险因素。147例进行了术中Ⅲ~Ⅳ区淋巴结活检快速病理检查,阳性灵敏度为88.4%,特异度98.4%。结论 甲状腺微小乳头状癌患者颈侧区淋巴结转移与患者年龄、肿瘤直径以及中央区淋巴结转移有关;术中Ⅲ~Ⅳ区淋巴结活检快速病理检查是较好的发现颈侧区淋巴结转移方法。

Objective To investigate the clinicopathological features of thyroid micropapillary carcinoma and the risk factors of lateral lymph node metastasis(LLNM).Methods One hundred and ninetyfive thyroid micropapillary carcinoma patients diagnosed by postoperative pathology at the First Affiliated Hospital of Nanjing Medical University from Jan 2018 to Dec 2020 were retrospectively divided into metastasis group and non-metastasis group according to whether there were LLNM.The clinicopathological features of the two groups were analyzed by univariate analysis.Binary Logistic regression was used to analyze the independent risk factors of LLNM in thyroid micropapillary carcinoma.Results The central lymph node metastasis(CLNM)and LLNM rate among 195 patients with thyroid micropapillary carcinoma was 68.2%and 66.7%,respectively.Univariate analysis showed that there were significant differences between the two groups in patient age,tumor diameter,extrathyroidal extension,and CLMN(all P<0.05).Multivariate logistic regression analysis showed that age≤45 years(P=0.041),tumor diameter>5 mm(P=0.014),and CLNM(P<0.001)were independent risk factors for LLNM.147 patients accepted an intraoperative frozen pathological examination ofⅢ-Ⅳlymph nodes,the positive sensitivity was 88.4%,and the specificity was 98.4%.Conclusions LLNM in patients with thyroid micropapillary carcinoma is related to the patient age,tumor diameter,and CLNM.Intraoperative frozen pathological biopsy ofⅢ-Ⅳlymph nodes is a good method to detect lymph node metastasis in the lateral cervical region.