摘要
目的探讨甲状腺微小乳头状癌(PTMC)颈部淋巴结转移的危险因素。方法回顾性分析郑州大学第一附属医院甲状腺外科2016年1月-2018年6月收治的940例PTMC患者的临床资料,其中男性206例,女性734例,男女性别比例为1.0∶3.6;年龄范围18~78岁,平均(45.5±10.6)岁。分析患者的性别、年龄、癌灶长径、多灶性、BRAF^V600E基因突变、合并桥本氏甲状腺炎以及腺外侵犯情况与淋巴结转移的关系。采用SPSS 21.0软件进行统计学分析,组间比较采用χ^2检验或秩和检验,多因素分析采用logistic回归分析。结果中央区淋巴结转移(CLNM)患者397例(42.2%),侧区淋巴结转移(LLNM)患者104例(11.1%)。单因素分析显示,男性(χ^2=24.485,P<0.001)、年龄<55岁(χ^2=8.100,P=0.004)、双侧癌灶(χ^2=5.006,P=0.025)、癌灶长径较大(Z=-0.016,P<0.001)、BRAF^V600E基因突变(χ^2=4.918,P=0.027)的患者CLNM阳性比例更高,在男性(χ^2=6.584,P=0.010)、双侧癌灶(χ^2=26.669,P<0.001)、癌灶长径较大(Z=-4.991,P<0.001)、腺外侵犯(χ^2=16.862,P<0.001)的患者中,LLNM阳性比例更高。多因素logistic回归分析结果显示,性别(OR=2.091,P<0.001)、年龄(OR=1.551,P=0.010)、癌灶长径(OR=5.285,P<0.001)、BRAF^V600E基因突变(OR=1.648,P=0.038)是PTMC患者CLNM的独立危险因素;性别(OR=1.657,P=0.032)、双侧癌灶(OR=2.610,P<0.001)、癌灶长径(OR=7.420,P<0.001)、腺外侵犯(OR=2.611,P=0.005)是LLNM的独立危险因素。癌灶长径在CLNM、LLNM风险评估的最佳临界值分别为0.6、0.8 cm。结论临床颈淋巴结阴性的PTMC患者存在淋巴结转移危险因素时,建议预防性清扫中央区淋巴结,并结合癌灶腺外侵犯情况综合考虑预防性清扫侧区淋巴结。
Objective To investigate the clinical and pathological characteristics of cervical lymph node metastasis in papillary thyroid microcarcinoma(PTMC),and provide a basis for the individualized surgical procedure.Methods Retrospectively analyzed the clinical data of 940 PTMC patients admitted to the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,from January 2016 to June 2018,including 206 males and 734 females,with a gender ratio of 1.0∶3.6.Age ranged from 18 to 78,with an average of(45.5±10.6)years.The correlation between gender,age,cancer size,multifocality,BRAF^V600E gene mutation,complicated with hashimoto′s thyroiditis,extrathyroidal extension and lymph node metastasis were analyzed.SPSS 21.0 software was used for statistical analysis.Chi-square test or rank sum test was adopted for comparison between groups,and logistic regression analysis was adopted for multivariate analysis.Results There were 397(42.2%)patients with central lymph node metastasis(CLNM)and 104(11.1%)patients with lateral lymph node metastasis(LLNM).Univariate analysis showed that male,age<55 years old(χ^2=24.485,P<0.001),bilateral cancer foci(χ^2=8.100,P=0.004),larger length-diameter(Z=-0.016,P<0.001),and BRAF^V600E gene mutation(χ^2=4.918,P=0.027)had a higher CLNM positive proportion,and LLNM positive proportion was higher in male(χ^2=6.584,P=0.010),bilateral cancer foci(χ^2=26.669,P<0.001),larger length-diameter(Z=-4.991,P<0.001),extra-glandular invasion(χ^2=16.862,P<0.001).Multivariate logistic regression analysis showed that gender(OR=2.091,P<0.001),age(OR=1.551,P=0.010),cancer lesion length(OR=5.285,P<0.001)and BRAF^V600E gene mutation(OR=1.648,P=0.038)were independent risk factors for CLNM in PTMC patients.Gender(OR=1.657,P=0.032),bilateral lesion(OR=2.610,P<0.001),tumor length diameter(OR=7.420,P<0.001)and extrathyroidal extension(OR=2.611,P=0.005)were independent risk factors for LLNM.The optimal critical values of tumor lesion length-diameter for risk assessment in CLNM and LLNM were 0.6 cm and 0.8 cm,respectively.Conclusions For PTMC patients with negative cervical lymph node had risk factors for lymph node metastasis,preventive dissection of central lymph nodes was recommended,and preventive dissection of lateral lymph nodes should also be comprehensively considered,by evaluating the extrathyroidal extension.
作者
王龙龙
李红强
薛文秀
李铄
殷德涛
Wang Longlong;Li Hongqiang;Xue Wenxiu;Li Shuo;Yin Detao(Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《国际外科学杂志》
2019年第12期805-809,共5页
International Journal of Surgery
基金
中原科技创新领军人才资助项目(194200510011)
河南省高校科技创新团队项目(19IRTSTHN002)。
关键词
外科手术
淋巴转移
颈淋巴结清扫术
甲状腺微小乳头状癌
Surgical procedures
operative
Lymphatic metastasis
Neck dissection
Papillary thyroid microcarcinoma
