摘要
目的探讨甲状腺乳头状癌气管前淋巴结转移的危险因素及其在手术决策的意义。方法研究2016年1月至2017年12月南京中医药大学附属中西医结合医院收治的275例甲状腺乳头状癌病人。分别统计其性别、年龄、肿瘤的最大直径、多灶性、侵犯被膜、伴区域淋巴结转移、伴有桥本甲状腺炎、BRAFV600E基因突变等特征,比较其与气管前淋巴结转移的关系。并制作患侧颈侧区淋巴结转移个数对诊断健侧中央区淋巴结转移的受试者工作特征ROC曲线。结果共98例(35.6%)有气管前淋巴结转移,单因素显示病人的年龄(P=0.003)、肿瘤长径(P<0.001)、多灶性(P<0.001)、侵犯被膜(P<0.001)、伴有桥本甲状腺炎(P<0.001)及BRAFV600E基因突变(P<0.001)与气管前淋巴结转移相关(P<0.05);多因素logistic回归分析示:肿瘤长径(P<0.001)、多发病灶(P=0.018)、BRAFV600E基因突变(P<0.001)是气管前淋巴结转移的独立危险因素。患侧颈侧区淋巴结转移个数对诊断健侧中央区淋巴结转移的ROC曲线下面积为0.913(P<0.05),临界值为3(个)。结论临床病理特征对甲状腺乳头状癌气管前淋巴结转移具有一定的预测价值;同时,对于快速病理显示气管前淋巴结转移的单侧PTC病人,若患侧颈侧区淋巴结转移数大于3个,需行健侧中央区淋巴结清扫。
Objective To investigate the risk factors of anterior tracheal lymph node metastasis in thyroid papillary carcinoma sur⁃gery and its value of adjuvant diagnosis.Methods The medical records of 275 consecutive patients with papillary thyroid carcino⁃ma(PTC)admitted to the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine from January 2016 to Decem⁃ber 2017 were analyzed retrospectively.Statistics of the gender,age,tumor longest diameter,multifocality,extrathyroidal extension,lymph node metastasis,combining with Hashimoto’s thyroiditis,BRAFV600E mutation were investigated for assessment of the correla⁃tive factors associated with pretracheal lymph node metastasis.The working characteristic curve of the number of lymph node metas⁃tases in the affected side of the neck was made for the diagnosis of lymph node metastasis in the central part of the healthy side.Results A total of 98 patients(35.6%)had pretracheal lymph node metastasis,which was correlated with age(P=0.003),maxi⁃mum tumor diameter(P<0.001),multifocal(P<0.001),invasion of the capsule(P<0.001),hashimoto thyroiditis(P<0.001)and BRAFV600E gene mutation(P<0.05).Multivariate logistic regression analysis showed that tumor length diameter(P<0.001),multiple lesions(P=0.018)and BRAFV600E gene mutation(P<0.001)were independent risk factors for pretracheal lymph node metastasis.The area under ROC curve of the number of lymph node metastases in the affected cervical region to the diagnosis of lymph node metastases in the central region of the healthy side was 0.913(P<0.05),and the critical value was 3.Conclusions Clinical and pathological features have certain predictive value for pretracheal lymph node metastasis.And for unilateral PTC pa⁃tients with rapid pathologic findings of pretracheal lymph node metastasis,when lymph node metastases in the cervical region of the affected side is more than 3,dissection of the healthy side should be considered.
作者
尹晓阳
王建华
江晶晶
徐书杭
季沁
周一帆
YIN Xiaoyang;WANG Jianhua;JIANG Jingjing;XU Shuhang;JI Qin;ZHOU Yifan(Department of General Surgery,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210028,China;Department of Endocrinology,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Nanjing,Jiangsu 210028,China)
出处
《安徽医药》
CAS
2020年第1期90-94,共5页
Anhui Medical and Pharmaceutical Journal
基金
江苏省“六大人才高峰”项目（2013-WSN-603）
江苏省卫健委课题（BJ18029)
