摘要
目的探讨右侧甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)患者年龄、性别、肿瘤特征及Ⅵa区转移淋巴结数量对Ⅵb区淋巴结转移的影响。方法205例右侧PTMC患者,观察其淋巴结转移情况,根据Ⅵb区淋巴结转移情况分为转移组36例和未转移组169例,比较2组临床和病理资料;采用多因素logistic回归分析右侧PTMC患者Ⅵb区淋巴结转移的危险因素;绘制ROC曲线,评估右侧PTMC患者Ⅵa区转移淋巴结数量对Ⅵb区淋巴结转移的预测价值。结果205例患者Ⅵa区转移99例(48.3%),Ⅵb区转移36例(17.6%),Ⅵa与Ⅵb区均转移33例(16.1%),Ⅵa区转移Ⅵb区未转移66例(32.2%),Ⅵa区未转移Ⅵb区转移3例(1.5%),Ⅵa、Ⅵb区均未转移103例(50.2%);Ⅵa区转移淋巴结数量1~10枚。转移组年龄≤45岁、男性、肿瘤直径>5 mm、肿瘤多发、腺外侵犯、Ⅵa区淋巴结转移比率(72.2%、36.1%、77.8%、72.2%、36.1%、91.7%)高于未转移组(40.8%、17.8%、58.6%、16.6%、3.6%、39.1%)(P<0.05)。肿瘤多发(OR=4.595,95%CI:1.744~12.107,P=0.002)、腺外侵犯(OR=19.097,95%CI:4.497~81.096,P<0.001)、Ⅵa区淋巴结转移(OR=11.588,95%CI:2.793~48.072,P=0.001)是右侧PTMC患者Ⅵb区淋巴结转移的独立危险因素。右侧PTMC患者Ⅵa区转移淋巴结数量最佳截断值为2.5个时,预测Ⅵb区淋巴结转移的AUC为0.781(95%CI:0.681~0.881,P<0.001),灵敏度为78.8%,特异度为69.7%。结论肿瘤多发、腺外侵犯、Ⅵa区转移淋巴结数量≥3个的右侧PTMC患者易出现颈部Ⅵb区淋巴结转移。
Objective To investigate the influences of the patients’age,gender,tumor features and the number of metastatic lymph nodes inⅥa onⅥb metastasis in patients with right papillary thyroid microcarcinoma(PTMC).Methods Totally 205 patients with right PTMC were observed the lymph nodes metastasis and were divided into metastatic group(n=36)and no-metastatic group(n=169)according to lymph node metastasis in Ⅵb.The clinical and pathological data were compared between two groups.Multivariate logistic regression analysis was used to assess the risk factors of Ⅵb metastasis.ROC was drawn to evaluate the value of the number of metastatic lymph nodes in Ⅵa to the prediction of Ⅵb metastasis.Results In 205 patients,there were 99 patients(48.3%)with Ⅵa metastasis,36(17.6%)with Ⅵb metastasis,33(16.1%)with both Ⅵa and Ⅵb metastases,66(32.2%)withⅥa metastasis and no Ⅵb metastasis,3(1.5%)with no Ⅵa metastasis but Ⅵb metastasis,and 103(50.2%)with neither Ⅵ ametastasis nor Ⅵb metastasis.There were 1 to 10 metastatic lymph nodes in Ⅵa.The percentages of patients aged ≤45 years,male,tumor diameter>5 mm,multiple tumors,extrathyroidal extension and Ⅵa metastasis were higher in metastatic group(72.2%,36.1%,77.8%,72.2%,36.1%,91.7%)than those in no-metastatic group(40.8%,17.8%,58.6%,16.6%,3.6%,39.1%)(P<0.05).Multiple tumors(OR=4.595,95%CI:1.744-12.107,P=0.002),extrathyroidal extension(OR=19.097,95%CI:4.497-81.096,P<0.001),and Ⅵa metastasis(OR=11.588,95%CI:2.793-48.072,P=0.001)were the independent risk factors of Ⅵb metastasis.When the optimal cut-off value of the number of metastatic lymph nodes in Ⅵa was 2.5,the AUC for predicting Ⅵb metastasis was 0.781(95%CI:0.681-0.881,P<0.001),the sensitivity was 78.8%,and the specificity was 69.7%.Conclusion Patients with multiple tumors,extraglandular invasion,and≥3 metastatic lymph nodes in Ⅵa are prone to have cervical lymph node metastasis in Ⅵb.
作者
卢昂
苏自杰
李国庆
李红光
LU Ang;SU Zijie;LI Guoqing;LI Hongguang(Department of Thyroid Surgery,Henan University People's Hospital,Henan Provincial People's Hospital Zhengzhou 450003,China)
出处
《中华实用诊断与治疗杂志》
2020年第12期1209-1211,共3页
Journal of Chinese Practical Diagnosis and Therapy
