甲状腺乳头状癌颈淋巴结跳跃性转移因素Logistic回归分析
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摘要
目的探讨影响甲状腺乳头状癌颈淋巴结跳跃性转移的相关危险因素。方法回顾性分析2013年6月至2018年1月161例甲状腺癌患者行甲状腺切除术的临床资料,根据是否发生淋巴结跳跃性转移分为两组,运用SPSS 24.2软件进行统计分析。分类及等比数据采用频数、构成比进行统计描述,比较采用χ~2检验。对单因素分析有意义的变量进行Logistic回归分析;以P<0.05为差异有统计学意义。结果 161例患者中共有25例患者发生淋巴结跳跃性转移,淋巴结跳跃性转移发生率为15.5%;单因素分析显示年龄、肿瘤大小及肿瘤位置则与跳跃性转移的发生密切相关(P<0.05);多因素分析结果显示,原发灶直径≤1 cm(OR=0.182, 95%CI=0.070～0.472,P=0.000)与肿瘤累位于甲状腺上极(OR=0.218, 95%CI=0.082～0.574,P=0.002)均为跳跃性颈侧区淋巴转移的独立危险因素。结论甲状腺乳头状癌患者肿瘤位置位于上极、直径≤1 cm与跳跃转移密切相关;对于此类患者必要时需行患侧颈侧区淋巴结清扫,以降低临床甲状腺乳头状癌术后淋巴结转移风险。
Objective To explore the related risk factors of cervical lymph node jumping metastasis in papillary thyroid carcinoma. Methods A total of 161 patients with thyroid cancer who underwent thyroidectomy in our hospital from June 2013 to January 2018 were collected and divided into two groups according to the occurrence of lymph node jumping metastasis, the clinical data were analyzed by SPSS 24.2 software. The data of class and geometric data were statistically described by frequency and constituent ratio, and compared by chi square test. Logistic regression analysis was used to analyze significant variables in univariate analysis. In this study, the difference in P<0.05 was statistically significant. Results A total of 25 cases of 161 patients had lymph node jumping metastasis and the incidence of lymph node jumping metastasis was 15.5%. Univariate analysis showed that age, tumor size and tumor location were closely related to the incidence of skip metastasis(P<0.05). Multivariate analysis showed that the primary tumor less than 1 cm(OR=0.182, 95%CI=0.070～0.472, P=0.000) and the tumor located at the upper pole of the thyroid gland(OR=0.218, 95%CI=0.082～0.574, P=0.002)was an independent risk factor of skipping cervical lateral lymph node metastasis. Conclusion The location of the tumor in the upper pole and ≤1 cm are closely related to the jumping metastasis in patients with papillary thyroid carcinoma. For these patients, lateral neck lymph node dissection is recommend to reduce the recurrence risk of clinical papillary thyroid carcinoma when necessary.
Objective To explore the related risk factors of cervical lymph node jumping metastasis in papillary thyroid carcinoma. Methods A total of 161 patients with thyroid cancer who underwent thyroidectomy in our hospital from June 2013 to January 2018 were collected and divided into two groups according to the occurrence of lymph node jumping metastasis, the clinical data were analyzed by SPSS 24.2 software. The data of class and geometric data were statistically described by frequency and constituent ratio, and compared by chi square test. Logistic regression analysis was used to analyze significant variables in univariate analysis. In this study, the difference in P<0.05 was statistically significant. Results A total of 25 cases of 161 patients had lymph node jumping metastasis and the incidence of lymph node jumping metastasis was 15.5%. Univariate analysis showed that age, tumor size and tumor location were closely related to the incidence of skip metastasis(P<0.05). Multivariate analysis showed that the primary tumor less than 1 cm(OR=0.182, 95%CI=0.070～0.472, P=0.000) and the tumor located at the upper pole of the thyroid gland(OR=0.218, 95%CI=0.082～0.574, P=0.002)was an independent risk factor of skipping cervical lateral lymph node metastasis. Conclusion The location of the tumor in the upper pole and ≤1 cm are closely related to the jumping metastasis in patients with papillary thyroid carcinoma. For these patients, lateral neck lymph node dissection is recommend to reduce the recurrence risk of clinical papillary thyroid carcinoma when necessary.
引文
[1] 高明,魏松锋.不断提高分化型甲状腺癌外科诊治规范化水平[J/CD].中华普外科手术学杂志:电子版,2016,10(5):361-364.
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[3] Nguyen MT, Hu J, Hastings KG, et al.Thyroid cancer mortality is higher in Filipinos in the United States: An analysis using National Mortality Records from 2003 through 2012[J]. Cancer, 2017, 123(24):4860-4867.
[4] 张浩.分化型甲状腺癌术后复发的处理策略[J/CD].中华普外科手术学杂志:电子版,2016,10(5):373-375.
[5] Xu JM, Xu XH, Xu HX, et al. Prediction of cervical lymph node metastasis in patients with papillary thyroid cancer using combined conventional ultrasound, strain elastography, and acoustic radiation force impulse (ARFI) elastography[J].European Radiology,2016, 26(8):2611-2622.
[6] Ji YB, Yoo HS, Song CM, et al.Predictive factors and pattern of central lymph node metastasis in unilateral papillary thyroid carcinoma[J]. Auris Nasus Larynx, 2016, 43(1):79-83.
[7] Wang TS, Evans DB.Commentary on: Occult lymph node metastasis and risk of regional recurrence in papillary thyroid cancer after bilateral prophylactic central neck dissection: A multi-institutional study[J].Surgery, 2017, 161(2):472-474.
[8] Kumar C,Saha S,Gour K.Comments on: Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study[J]. Surgery, 2016, 159(5): 1483-1484.
[9] 胡代星,周静,苏新良,等.甲状腺乳头状癌颈侧区淋巴结跳跃转移危险因素分析[J].中国肿瘤临床, 2017, 44(22):1141-1145.
[10] Eweida AM, Sakr MF, Hamza Y, et al. Level I lymph node involvement in patients with N1b papillary thyroid carcinoma: a prospective study[J].Eur Arch Otorhinolaryngol,2017, 274(4): 1951-1958.
[11] Lei J, Zhong J, Jiang K, et al.Skip lateral lymph node metastasis leaping over the central neck compartment in papillary thyroid carcinoma[J]. Oncotarget, 2017, 8(16):27022-27033.
[12] Davies L, Morris L, Hankey B.Increases in Thyroid Cancer Incidence and Mortality[J].JAMA, 2017, 318(4): 389-390.
[2] 田文,姚京.分化型甲状腺癌术前分期与术式选择[J/CD].中华普外科手术学杂志:电子版,2016,10(5):365-367.
[3] Nguyen MT, Hu J, Hastings KG, et al.Thyroid cancer mortality is higher in Filipinos in the United States: An analysis using National Mortality Records from 2003 through 2012[J]. Cancer, 2017, 123(24):4860-4867.
[4] 张浩.分化型甲状腺癌术后复发的处理策略[J/CD].中华普外科手术学杂志:电子版,2016,10(5):373-375.
[5] Xu JM, Xu XH, Xu HX, et al. Prediction of cervical lymph node metastasis in patients with papillary thyroid cancer using combined conventional ultrasound, strain elastography, and acoustic radiation force impulse (ARFI) elastography[J].European Radiology,2016, 26(8):2611-2622.
[6] Ji YB, Yoo HS, Song CM, et al.Predictive factors and pattern of central lymph node metastasis in unilateral papillary thyroid carcinoma[J]. Auris Nasus Larynx, 2016, 43(1):79-83.
[7] Wang TS, Evans DB.Commentary on: Occult lymph node metastasis and risk of regional recurrence in papillary thyroid cancer after bilateral prophylactic central neck dissection: A multi-institutional study[J].Surgery, 2017, 161(2):472-474.
[8] Kumar C,Saha S,Gour K.Comments on: Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study[J]. Surgery, 2016, 159(5): 1483-1484.
[9] 胡代星,周静,苏新良,等.甲状腺乳头状癌颈侧区淋巴结跳跃转移危险因素分析[J].中国肿瘤临床, 2017, 44(22):1141-1145.
[10] Eweida AM, Sakr MF, Hamza Y, et al. Level I lymph node involvement in patients with N1b papillary thyroid carcinoma: a prospective study[J].Eur Arch Otorhinolaryngol,2017, 274(4): 1951-1958.
[11] Lei J, Zhong J, Jiang K, et al.Skip lateral lymph node metastasis leaping over the central neck compartment in papillary thyroid carcinoma[J]. Oncotarget, 2017, 8(16):27022-27033.
[12] Davies L, Morris L, Hankey B.Increases in Thyroid Cancer Incidence and Mortality[J].JAMA, 2017, 318(4): 389-390.