甲状腺微小乳头状癌颈侧区淋巴结转移相关因素分析及预测价值

Analysis of correlation factors of lateral lymph node metastasis in papillary thyroid microcarcinoma and predictive value

目的:探讨甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)颈侧区淋巴结转移的相关因素,评价其预测价值,为临床治疗提供参考依据。方法:选取2022年6月—2023年6月于郑州大学附属肿瘤医院手术的PTMC患者158例,根据术后病理学检查结果(颈侧区淋巴结有无转移)分为未转移组(95例)和转移组(63例),分析并比较两组患者临床资料及术前超声资料,采用单因素分析和多因素logistic回归分析筛选出颈侧区淋巴结转移的独立相关因素,绘制受试者工作特征(receiver operating characteristic,ROC)曲线评价各因素及联合指标的预测效能。结果:单因素分析结果显示,患者年龄、性别、肿瘤最大径、位置、纵横比>1、微钙化、侵犯被膜、超声提示中央区异常淋巴结、颈侧区淋巴结长短径之比≤2、囊性变、微钙化、边缘或混杂血流信号、淋巴门回声不均、淋巴门偏心或消失在两组之间的差异有统计学意义(P<0.05),多因素logistic回归分析显示年龄≤45岁、肿瘤位于上极、侵犯被膜、超声提示中央区异常淋巴结、颈侧区淋巴结淋巴门回声不均是PTMC患者颈侧区淋巴结发生转移的独立危险因素。由独立危险因素构成的联合指标预测颈侧区淋巴结转移的灵敏度、特异度、准确度分别为81.0%、86.3%、84.2%,ROC曲线的曲线下面积为0.918。结论:年龄、肿瘤位置、被膜侵犯、超声提示中央区异常淋巴结、颈侧区淋巴结淋巴门回声不均联合可有效地预测PTMC患者颈侧区淋巴结转移,为临床治疗方案的选择提供帮助。

Objective:To explore the factors related to lateral lymph node metastasis in papillary thyroid microcarcinoma(PTMC)and their predictive value,so as to provide reference for clinical treatment.Methods:A total of 158 PTMC patients who underwent surgery in the Affiliated Cancer Hospital of Zhengzhou University from June 2022 to June 2023 were divided into non-metastatic group(95 cases)and metastatic group(63 cases)according to postoperative pathological results.Their clinical data and preoperative ultrasound data were analyzed and compared.Single factor analysis and multiple logistic regression analysis were used to screen out the independent correlation factors of lateral lymph node metastasis.Receiver operating characteristic(ROC)curve was drawn to evaluate the prediction efficiency of each factor and the combined index.Results:The results of single factor analysis showed there were statistically significant differences in age,gender,maximum tumor diameter,location,transverse-longitudinal axis ratio>1,microcalcification,invasion capsule,ultrasonography indicating abnormal central lymph nodes,the ratio of length to diameter of lymph nodes in the lateral region≤2,uneven hilum of lymph node echo,cystic change,microcalcification,and marginal or mixed blood flow signals between the two groups(P<0.05).Multivariate logistic regression analysis showed that age≤45 years,tumor in the upper pole,invasion of capsule,ultrasonography indicating abnormal central lymph nodes,and uneven hilum of lymph node echo of lateral lymph nodes were independent risk factors for lateral lymph node metastasis in PTMC patients.The sensitivity,specificity and accuracy of the combined index composed by independent risk factors in predicting lateral lymph node metastasis respectively were 81.0%,86.3%and 84.2%,and the area under ROC curve was 0.918.Conclusion:The combination of age,tumor location,capsular invasion,ultrasonography indicating abnormal central lymph nodes,and uneven hilum of lymph node echo of lateral lymph nodes can effectively predict the metastasis of lateral lymph nodes in PTMC patients,and provide help for the selection of clinical treatment.