摘要
目的通过分析监测、流行病学和最终结果 (SEER)数据库资料,探索甲状腺乳头状微癌(PTMC)淋巴结转移的危险因素。方法回顾性分析2002至2012年SEER数据库中共计31 017例PTMC患者资料,采用Logistic及Cox回归分析探索各因素与PTMC淋巴结转移风险的关联性。结果多因素分析显示,男性(OR=0. 673,95%CI=0. 605～0. 748,P=0. 001)、年龄<55岁(OR=0. 683,95%CI=0. 623～0. 749,P=0. 001)、肿瘤大小> 5 mm (OR=1. 172,95%CI=1. 153～1. 191,P=0. 001)、组织类型为滤泡型(OR=0. 641,95%CI=0. 574～0. 716,P=0. 001)、多灶性(OR=1. 662,95%CI=1. 516～1. 821,P=0. 001)和腺外侵犯(ETE)(包膜侵犯OR=1. 232,95%CI=1. 183～1. 543,P=0. 001,微小侵犯OR=2. 119,95%CI=1. 377～3. 263,P=0. 001,大体侵犯OR=2. 546,95%CI=2. 218～2. 921,P=0. 001)与中央区淋巴结转移显著相关。多因素分析显示,肿瘤大小>5 mm (OR=1. 112,95%CI=1. 091～1. 133,P=0. 001)、男性(OR=0. 36,95%CI=0. 322～0. 401,P=0. 001)、年龄<55岁(OR=0. 503,95%CI=0. 453～0. 559,P=0. 001)、组织类型为滤泡型(OR=0. 625,95%CI=0. 549～0. 711,P=0. 001)、多灶性(OR=2. 265,95%CI=2. 039～2. 517,P=0. 001)、ETE (包膜侵犯OR=2. 105,95%CI=1. 681～2. 637,P=0. 001;微小侵犯OR=4. 601,95%CI=3. 994～5. 300,P=0. 001;大体侵犯OR=7. 093,95%CI=4. 910～10. 246,P=0. 001)及远处转移(OR=11. 948,95%CI=7. 523～18. 975,P=0. 001)与侧颈区淋巴结转移显著相关。结论男性、年轻(<55岁)、肿瘤较大(> 5 mm)、滤泡型PTMC、ETE和多灶性是颈部淋巴结转移的危险因素。远处转移也是侧颈区淋巴结转移的相关因素。对高风险的PTMC患者,推荐行预防性颈部淋巴结清扫术。
Objective To explored the risk factors of lymph node metastasis in papillary thyroid microcarcinoma(PTMC)by analyzing the data from the Surveillance,Epidemiology and End Results(SEER)database.Methods The data of 31 017 patients with PTMC in the SEER database from 2002 to 2012 were retrospectively analyzed.Logistic and Cox regression analyses were used to explore the associations of the factors and the risk of lymph node metastasis in PTMC.Results Multivariate analysis revealed that male(OR=0.673,95%CI=0.605-0.748,P=0.001),age<55 years(OR=0.683,95%CI=0.623-0.749,P=0.001),tumor size>5 mm(OR=1.172,95%CI=1.153-1.191,P=0.001),follicular variant(OR=0.641,95%CI=0.574-0.716,P=0.001),and multifocal(OR=1.662,95%CI=1.516-1.821,P=0.001)and external thyroid extension(ETE)(capsular invasion OR=1.232,95%CI=1.183-1.543,P=0.001;minor invasion OR=2.119,95%CI=1.377-3.263,P=0.001;and gross invasion OR=2.546,95%CI=2.218-2.921,P=0.001)were significantly associated with central lymph node metastasis(CLNM).Multivariate analysis revealed that tumor size>5 mm(OR=1.112,95%CI=1.091-1.133,P=0.001),male(OR=0.36,95%CI=0.322-0.401,P=0.001),age<55 years(OR=0.503,95%CI=0.453-0.559,P=0.001),follicular variant(OR=0.625,95%CI=0.549-0.711,P=0.001),multifocal(OR=2.265,95%CI=2.039-2.517,P=0.001),ETE(capsular invasion OR=2.105,95%CI=1.681-2.637,P=0.001;minor invasion OR=4.601,95%CI=3.994-5.300,P=0.001;and gross invasion OR=7.093,95%CI=4.910-10.246,P=0.001),and distant metastasis(OR=11.948,95%CI=7.523-18.975,P=0.001)were significantly associated with lateral lymph node metastasis.Conclusions Male,young age(<55 years),large tumor(>5 mm),follicular variant-PTMC,ETE,and multifocality are the risk factors for cervical lymph node metastasis.Distant metastasis is associated with lateral lymph node metastasis.For patients at high risk of PTMC,prophylactic neck lymph node dissection is recommended.
作者
郑克思
曾勇
陈聪
吴元肇
陈碧
应文兵
郑克文
ZHENG Kesi;ZENG Yong;CHEN Cong;WU Yuanzhao;CHEN Bi;YING Wenbing;ZHENG Kewen(Department of Oncology,Wenzhou People’s Hospital,the Third Clinical College of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;Department of Urology,the First Affiliated Hospital of Wenzhou Medical University,the First Clinical College of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China)
出处
《中国医学科学院学报》
CAS
CSCD
北大核心
2018年第6期736-743,共8页
Acta Academiae Medicinae Sinicae
基金
温州市公益性科技计划项目(Y20160336
Y20170752)
浙江省自然科学基金(LQ17H050002)~~
关键词
甲状腺乳头状微癌
颈部淋巴结转移
危险因素
papillary thyroid microcarcinoma
cervical lymph node metastasis
risk factors
