甲状腺乳头状癌淋巴结跳跃性转移危险因素及分布特征分析

Risk factors and distribution characteristics for skip metastasis in papillary thyroid carcinoma

目的探讨甲状腺乳头状癌(PTC)患者淋巴结跳跃性转移的危险因素及分布特征。方法回顾性分析2014年1月至2021年12月空军军医大学西京医院720例经术后病理证实颈侧区淋巴结转移PTC患者的临床资料,根据患者淋巴结是否存在跳跃性转移分为跳跃转移组(92例)和非跳跃转移组(628例)。结果本组PTC患者淋巴结跳跃性转移率为12.7%(92/720)。女性(OR=1.890,95%CI:1.118~3.198,P=0.018)、年龄≥55岁(OR=2.508,95%CI:1.412~4.454,P=0.002)、肿瘤累及上极(OR=1.919,95%CI:1.220~3.018,P=0.005)以及病灶位于单侧腺叶(OR=1.926,95%CI:1.153~3.214,P=0.012)是淋巴结跳跃性转移的独立危险因素。淋巴结跳跃性转移最容易发生于Ⅲ区,其次分别为Ⅳ区、Ⅱ区、Ⅴ区。对于跳跃性转移至Ⅲ区和Ⅳ区的淋巴结,病灶越大跳跃性转移的数目越多(P=0.001、0.016)。结论对于年龄≥55岁、肿瘤累及上极、病灶分布于单侧腺叶的女性PTC患者要高度警惕颈侧区淋巴结跳跃性转移的可能性。

ObjectiveTo investigate the risk factors and distribution characteristics for skip lateral lymph node metastasis in patients of papillary thyroid carcinoma(PTC).MethodsClinical data of 720 PTC patients with postoperative pathologically confirmed lymph node metastasis in the lateral cervical region at Xijing Hospital of Air Force Military Medical University from Jan 2014 to Dec 2021 were retrospectively analyzed.According to whether there is skip metastasis in the lymph nodes of the patients,patients were divided into skip metastasis group(92 cases)and non-skip metastasis group(628 cases).ResultsThe rate of lymph node skip metastasis in PTC in this study was 12.7%(92/720).Women(OR=1.890,95%CI:1.118-3.198,P=0.018),age≥55 years(OR=2.508,95%CI:1.412-4.454,P=0.002),tumor involving the upper pole(OR=1.919,95%CI:1.220-3.018,P=0.005),and unilateral glandular lobe lesions(OR=1.926,95%CI:1.153-3.214,P=0.012)were independent risk factors for lymph node skip metastasis.Skip metastasis is most likely to occur in regionⅢ,followed by regionⅥ,ⅡandⅤ.Larger cancer tended to have more than one jumping metastases in regionsⅢandⅣ(P=0.001,0.016).ConclusionIn female PTC patients,age≥55 years,tumors involving upper pole,and unilateral lesions,are all the hazardous factor for skip metastasis in the lateral neck region.