摘要
目的 探究早期(T1、T2,N0M0)cN0甲状腺乳头状癌(PTC)发生隐匿性中央区淋巴结转移的危险因素并构建预测模型,结合预防性中央区淋巴结清扫术(PCLND)的并发症发生率,为早期cN0 PTC的PCLND提供决策依据。方法 回顾性分析454例早期cN0 PTC患者的临床资料,进行统计学分析,并统计入组患者术后并发症发生率。结果 男性、年龄≤45岁、直径>1 cm、砂砾体/微钙化形成是隐匿性中央区淋巴结转移的独立危险因素。依据独立危险因素建立预测模型:Logit(P)=-1.735-0.717×性别+0.442×年龄+1.245×肿瘤直径+1.349×砂砾体/微钙化形成。与其他研究相比,本研究PCLND并未显著增加并发症发生率。结论 建立的早期cN0 PTC隐匿性中央区淋巴结转移的预测模型有较好的预测效果及实用价值。术前可使用此模型计算隐匿性中央区转移的概率,P值越大,淋巴结转移风险越大,越应该行PCLND。本次研究术后暂时性并发症发生率并未增加,可见规范的手术步骤及良好的手术技巧可提高PCLND的安全性。由于早期cN0 PTC隐匿性中央区淋巴结转移的比例较高(本研究为33.3%),因此对此类患者应积极行PCLND,以清除可能存在的隐匿恶性淋巴结,前提是手术团队的水平能够不增加并发症风险。
Objective In this study, we explore the risk factors and construct a predictive model for the occult central lymph node metastasis in early cN0 papillary thyroid carcinoma(PTC), combining with the complication rate of prophylactic central lymph node dissection(PCLND), to provide its decision basis. Methods Clinical data of 454 early cN0 PTC patients was retrospectively analyzed. And the incidence of complications was collected. Results Male, age ≤45, diameter>1 cm, and formation of microcalcifications were independent risk factors for occult central lymph node metastasis. A prediction model for occult lymph node metastasis in the central region was established: Logit(P) =-1.735-0.717×gender +0.442×age +1.245×tumor diameter +1.349×microcalcifications. And our PCLND did not increase the incidence of complications. Conclusion The model should be used to calculate the probability of occult central lymph node metastasis before surgery. The larger the P-value is, the higher the risk of lymph node metastasis will be, and PCLND should be performed for these patients. The incidence of temporary postoperative complications in our study is lower than other studies, which showing surgery with good skills will not increase the complication incidence after PCLND. Thus, for the possibility of occult central lymph node metastasis(33% in our study), PCLND should be actively performed in all patients with early cN0 PTC to remove possible occult malignant lymph nodes.
作者
肖富亮
林云
潘新良
XIAO Fuliang;LIN Yun;PAN Xinliang(Department of Otorhinolaryngology&Head and Neck Surgery,Qilu Hospital of Shandong University(Qingdao),Qingdao 266035,Shandong,China)
出处
《山东大学耳鼻喉眼学报》
CAS
2023年第1期64-71,共8页
Journal of Otolaryngology and Ophthalmology of Shandong University
关键词
甲状腺乳头状癌
中央区淋巴结转移
危险因素
预测模型
Papillary thyroid carcinoma
Central lymph node metastasis
Risk factors
Predictive model
