颈侧淋巴结(N1b)转移与甲状腺乳头状癌预后的相关性分析

Correlation between cervical lymph node metastasis and prognosis of papillary thyroid carcinoma

目的探讨颈侧淋巴结转移(N1b)与甲状腺乳头状癌(papillary thyroid carcinoma,PTC)预后的相关性。方法对2015年4月至2017年3月收治并确诊为PCT的患者共165例进行回顾性分析,所有患者行LN清扫术,LN送病理科检验。依据LN转移情况进行分组,N0组57例(34.5%)、N1a组64例(38.8%)和N1b组44例(26.7%)。结果 N1b组(39.8,30.7～51.6)和N1a组(40.1,31.3～50.1)的诊断年龄显著低于N0组(44.7,36.6～55.0);N1b组的女性比例高于N1a组与N0组(F/M=1.9/1、3.9/1和5.3/1);复发方面:N1b组(31.8%)显著高于N1a组(15.6%),N1a组显著高于N0组(7.0%),以上差异均有统计学意义(P<0.05);远处转移方面,N1b组(13.6%)显著高于N1a组(6.0%)和N0组(1.7%),差异均有统计学意义(P<0.05);LN转移数目> 5且N1b转移PTC复发的独立危险因素。结论颈侧淋巴结转移是PTC复发和远处转移主要危险因素,因此术后风险管理应基于淋巴转移情况进行制订。

Objective To investigate the correlation between cervical lymph node metastasis(N1 b)and the prognosis of papillary thyroid carcinoma(PTC).Methods The clinical data about 165 patients with PTC who were admitted and treated in our hospital from April 2015 to March 2017 were retrospectively analyzed.All the patients underwent total thyroidectomy,and the LN was pathologically examined.According to the condition of LN metastasis,these patients were divided into N0 group(n=57),N1 a group(n=64)and N1 b group(n=44).Results The diagnostic age in N1 b group(39.8,30.7~51.6)and in N1 a group(40.1,31.3~50.1)was significantly lower than that in N0 group(44.7,36.6~55.0).The proportion of females in N1 b group was higher than that in N1 a group and N0 group(F/M=1.9/1,3.9/1,5.3/1,respectively).The relapse rate in N1 b group was 31.8%,which was significantly higher than that(15.6%)in N1 a group,which in N1 a group was significantly higher than that(7.0%)in N0 group(P<0.05).The distant metastasis rate in N1 b was 13.6%,which was significantly higher than that(6.0%)in N1 a group and that(1.7%)in N0 group(P<0.05).The LN metastasis number>5 and N1 b metastasis were the independent risk factors for PTC recurrence.Conclusion The cervical lymph node metastasis is a major risk factor for PTC recurrence and distant metastasis,thus,the postoperative risk management should be formulated according to lymphatic metastasis condition.