低危型甲状腺微小乳头状癌临床进程的超声观察及其增长的影响因素分析

Factors related to the growth of low-risk papillary thyroid microcarcinoma based on sequential ultrasonic observation

目的应用超声观察低危型甲状腺微小乳头状癌(PTMC)的临床进程,并分析其增长的影响因素。方法该研究为横断面研究,回顾性分析2017年10月至2023年12月大连大学附属中山医院健康管理中心体检者的甲状腺超声检查资料,应用超声观察低危型PTMC的大小变化及颈部淋巴结有无异常,通过比较增长组与非增长组体检者的临床特征及超声图像特征,分析低危型PTMC增长的影响因素。结果共有136例体检者136个低危型PTMC纳入研究。观察期间低危型PTMC增长23例(16.9%),未增长113例(83.1%);8例(5.9%)出现颈部淋巴结转移,其中增长组7例(30.4%),未增长组1例(0.9%),均未发现远处转移。增长组体检者的初诊年龄、初次检查最大直径、初次检查体积与未增长组相比差异有统计学意义(均P<0.05)。logistic回归分析显示初诊年龄和初次检查最大直径是低危型PTMC增长的影响因素,初诊年龄≤40岁者低危型PTMC增大的风险是初诊年龄>40岁者的4.299倍(OR=4.299,95%CI:1.662~12.175,P=0.003),初次检查最大直径每增加1 mm,低危型PTMC增大的风险降低0.446(OR=0.554,95%CI:0.317~0.969,P=0.038)。结论大部分低危型PTMC的大小在观察过程中未增长,且颈部淋巴结转移率较低,初诊年龄≤40岁和初次检查最大直径较小的低危型PTMC易增长,对适当年龄及大小的低危型PTMC患者可进行密切观察。

Objective To investigate the factors related to the tumor growth in subjects with low-risk papillary thyroid microcarcinoma(PTMC)based on ultrasonography.Methods This was a cross-sectional study.A total of 136 subjects who received health check-up in Health Management Center,the Affiliated Zhongshan Hospital of Dalian University from October 2017 to December 2023 were enrolled in the study.Low-risk PTMC were detected by ultrasonogrphy in those subjects and ultrashonography was followed up to observe the changes of maximum diameter and volume of the tumor,and metastasis of cervical lymph nodes.The clinical characteristics and ultrasonic image features were compared between the subjects with the tumor growth and without tumor growth,and the influencing factors of tumor growth were analyzed.Results Among 136 subjects with low-risk PTMC,there were 23 cases(16.9%)with tumor growth(growth group)and 113 cases(83.1%)without tumor growth(non-growth group).Cervical lymph node metastasis occurred in 8 cases(5.9%:7(30.4%)in the growth group and 1(0.9%)in non-growth group),no distant metastasis were detected.There were significantly differences in patients age of initial diagnoisi,maximum diameter and volume of tumors between the growth group and non-growth group(all P<0.05).Logistic regression analysis showed that age of initial diagnoisi≤40 years(OR=4.299,95%CI:1.662-12.175,P=0.003)was an independent risk factor for tumor growth and the maximum diameter of the initial examination was independent protective factor for tumor growth(increasing 1 mm of initial diameter:OR=0.554,95%CI:0.317-0.969,P=0.038).Conclusion The size of most low-risk PTMC detected by ultrasonography during the health check-up does not grow and the risk of cervical lymph node metastasis is low;however,for those with age of initial diagnoisi≤40 years and smaller size tumor,the risk of PTMC growth would be increased.