甲状腺癌诊疗规范化质量控制数字化平台的研发与应用

Analysis of the location and characteristics of postoperative recurrence of papillary thyroid carcinoma

目的探索甲状腺癌数智化质控平台对临床诊疗的质量控制效果。方法浙江省人民医院的甲状腺癌数智化质控平台于2022年7月底上线,一期部署了6项甲状腺癌诊疗规范质量控制指标,分析平台上线前后即2022年1月至2023年11月期间该6项质量控制指标数据的变化。结果与2022年1–7月比较,2023年7–11月甲状腺癌手术前细胞病理学检查率(t=–8.490,P<0.001)、甲状腺癌患者术后pTNM分期率(t=–3.027,P=0.013)升高,甲状腺癌患者中微创手术占比(t=4.085,P=0.002)降低。直线回归模型结果表明,平台上线后,随时间延长,甲状腺癌手术前细胞病理学检查率(P=0.001)和甲状腺癌患者术后pTNM分期率(P=0.049)呈逐步增高趋势。结论本研究初步结果表明,笔者团队所建立的甲状腺癌数智化质控平台能有效促进甲状腺癌临床诊疗规范化质量控制。

Objective To explore the location and characteristics of postoperative recurrence of papillary thyroid carcinoma.Methods The clinical data of 96 patients who underwent reoperation for papillary thyroid cancer at the Affiliated Cancer Hospital of Zhengzhou University from January 2017 to March 2024 were retrospectively analyzed.Results Out of 96 patients,3 had thyroid recurrence,89 had lymph node recurrence,and 4 had thyroid and lymph node recurrence.There were 69 cases of single recurrence and 27 cases of multiple recurrence.Ten cases underwent lobectomy and lateral area cleaning,8 cases underwent central area cleaning,33 cases underwent lateral area cleaning,and 45 cases underwent central area+lateral area cleaning.Postoperative pathological examination revealed that there was lymph node metastasis in 93 cases(16 cases in the central region,44 cases in the lateral region,and 33 cases in both the central and lateral regions),with 3 cases remaining non metastatic;58 cases had extracapsular invasion of lymph nodes.Compared with patients with multiple relapses,patients with single recurrence had younger age(t=–3.385,P=0.001),lower incidence of gross extracapsular invasion of lymph nodes during surgery(χ^(2)=6.970,P=0.008),higher number of metastatic lymph nodes(t=4.034,P=0.001),and higher rate of lymph node metastasis in zonesⅡ,Ⅲ,andⅣ(χ^(2)=8.142,P=0.004;χ^(2)=6.357,P=0.012;χ^(2)=12.547,P<0.001).Conclusions Postoperative recurrence of papillary thyroid cancer is mainly due to lymph node recurrence.The advanced age and the visible lymph node extracapsular invasion may increased risk of postoperative recurrence of papillary thyroid cancer.Lymph node metastasis in the central region is a possible cause of multiple relapses and surgeries.