甲状腺乳头状癌患者临床病理特征及中央区淋巴结转移危险因素分析

Clinicopathological characteristics of papillary thyroid carcinoma and risk factors of central lymph node metastasis

目的探讨甲状腺乳头状癌患者临床病理特征和中央区淋巴结转移的危险因素。方法收集2010年1月至2018年6月于河北省黄骅市人民医院普通外科确诊为甲状腺乳头状癌的130例患者的临床资料,分析患者中央区淋巴结转移的危险因素。结果本研究130例患者中发生中央区淋巴结转移61例(46. 9%)。单因素分析结果显示,肿瘤直径> 1 cm(P=0. 001)、合并桥本甲状腺炎(P=0. 006)、多发灶肿瘤(P <0. 001)、累及包膜(P <0. 001)与中央区淋巴结转移率有关。多因素Logistic分析结果显示,肿瘤直径> 1 cm(比值比=0. 382,95%置信区间:0. 178～0. 818,P=0. 013)、病灶多发(比值比=0. 206,95%置信区间:0. 093～0. 421,P=0. 002)和累及包膜(比值比=0. 348,95%置信区间:0. 162～0. 750,P=0. 007)是影响中央区淋巴结转移的独立危险因素。结论肿瘤直径> 1 cm、病灶多发和累及包膜的甲状腺乳头状癌患者在行肿瘤切除术时应联合行中央区淋巴结清扫。

Objective To analyze the clinical and pathological characteristics of papillary thyroid carcinoma( PTC) and the risk factors of central lymph node metastasis( CLNM). Methods Clinical data of 130 PTC patients admitted to Huanghua Municipal People’ s Hospital from January 2010 to June 2018 were retrospectively analyzed.Risk factors of CLNM were analyzed by logistic regression. Results There were 61 cases( 46. 9%) having CLNM. Single-factor analysis showed that tumor size > 1 cm( P = 0. 001),Hashimoto thyroiditis( P = 0. 006),multifocal thyroiditis( P < 0. 001) and thyroid capsule invasion( P < 0. 001) were related with CLNM. Multi-factor logistic analysis showed that tumor size > 1 cm( odds ratio = 0. 382,95% confidence interval: 0. 178-0. 818,P =0. 013),multifocal thyroiditis( odds ratio = 0. 206,95% confidence interval: 0. 093-0. 421,P = 0. 002) and thyroid capsule invasion( odds ratio = 0. 348,95% confidence interval: 0. 162-0. 750,P = 0. 007) were independent risk factors of CLNM. Conclusion PTC patients with tumor size > 1 cm,multifocal tumor and thyroid capsule involvement should have tumorectomy plus central lymph node dissection.