甲状腺上极乳头状癌侧颈区淋巴结转移的危险因素

Analysis of risk factors for lymph node metastasis in the lateral neck region of upper papillary thyroid carcinoma

目的 探讨甲状腺上极乳头状癌患者侧颈区淋巴结转移的相关危险因素,对于术前未发现侧颈区转移但存在危险因素的甲状腺上极乳头状癌患者,为其在术中进行侧颈区淋巴结转移的评估提供理论依据。方法 回顾性分析甲状腺上极乳头状癌194例患者的临床资料,单因素和多因素分析侧颈区淋巴结转移的独立危险因素。结果 单因素分析显示,肿瘤Braf基因、中央区淋巴结转移数目、纵横比、内部回声、内部钙化、血流信号、肿瘤大小、被膜被侵犯与甲状腺上极乳头状癌侧颈区淋巴结转移有关,P<0.05;多因素分析显示,中央区淋巴结转移数目>3、肿瘤大小为11~20 mm、纵横比>1、内部钙化、内部回声不均匀为侧颈区淋巴结转移的独立危险因素。结论 甲状腺上极乳头状癌患者中央区淋巴结转移数目、纵横比、内部钙化、内部回声、肿瘤大小是侧颈区淋巴结转移独立危险因素,对于术前未发现侧颈区转移但存在危险因素的甲状腺上极乳头状癌患者,在术中可积极进行侧颈区淋巴结转移的评估,必要时可行术中侧颈区淋巴结快速病理检查。

Objective To identify the risk factors associated with lymph node metastasis in the lateral neck region of patients with upper pole papillary thyroid cancer,and to establish a theoretical basis for intraoperative evaluation of lymph node metastasis in cases where no preoperative metastasis is detected in the lateral neck region.Methods We retrospectively analyzed patients diagnosed with upper pole papillary thyroid cancer to identify independent risk factors for lymph node metastasis in the lateral neck region.Results Univariate analysis revealed significant associations(P<0.05)between metastatic lymph node involvement in the lateral neck region of upper pole papillary thyroid carcinoma and the following factors:Braf gene,number of lymph node metastases in the central region,aspect ratio,internal echogenicity,internal calcification,blood flow signal,tumor size,and dorsal membrane invasion.The multivariate analysis identified the number of lymph node metastases in the central region>3,tumor size 11~20 mm,aspect ratio>1,internal calcification,and uneven internal echogenicity(P=0.016)as independent risk factors for lymph node metastasis in the lateral neck region.Conclusion In patients with upper pole papillary thyroid cancer,the presence of central lymph node metastasis,aspect ratio,internal calcification,internal echogenicity,and tumor size are independent risk factors for lateral cervical lymph node metastasis.For patients who exhibit risk factors without preoperative cervical metastasis,active evaluation of lateral cervical lymph node metastasis can be performed during surgery.Additionally,intraoperative rapid pathological examination of lateral cervical lymph nodes can be conducted when deemed necessary.