甲状腺微小乳头状癌中央区淋巴结转移相关因素及其预测能力分析
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摘要
目的探讨甲状腺微小乳头状癌(PTMC)中央区淋巴结转移相关因素及其预测能力。方法回顾性分析2012年3月至2016年8月首都医科大学附属北京安贞医院普外科243例PTMC手术患者的临床资料。分析手术时年龄、性别、肿瘤大小、病灶数量和被膜外侵犯等因素对PTMC中央区淋巴结转移的预测能力,并结合MACIS和AGES评分系统分别进行综合评判,分析以上指标与淋巴结转移的相关关系。结果 243例PTMC病例中男66例、女177例,淋巴结转移发生率为38.7%(94/243)。以是否发生中央区淋巴结转移分为转移组(94例)和未转移组(149例)进行分析。手术时年龄小[(41±10)岁比(45±12)岁]、肿瘤最大径大[7(1,10)mm比6(1,10)mm]和多发病灶[44.7%(42/94)比24.2%(36/149)]与发生淋巴结转移有关,组间差异有统计学意义(P=0.003、0.002、0.017);性别、是否侵犯被膜、MACIS评分、AGES评分与淋巴结转移不相关,组间差异无统计学意义(P=0.186、0.404、0.149、0.733)。受试者工作特征曲线分析显示,年龄为44.5岁时敏感度+特异度为最大值;肿瘤最大径为5.5 mm时敏感性+特异性为最大值。结论年龄<45岁、肿瘤最大径≥6 mm及多发癌灶与PTMC淋巴结转移发生率增加相关。
Objective To explore influence factors of central neck lymph node metastasis of papillary thyroid microcarcinoma( PTMC). Methods A retrospective study was conducted in 243 patients with PTMC who were operated in Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University from March2012 to August 2016. Clinical data including age, sex, tumor size, tumor numbers and extracapsular spread were recorded; MACIS and AGES scoring systems were assessed in all patients; correlation among these factors and central lymph node metastasis was analyzed. Results There were 66 males and 177 females; the lymph node metastasis rate was 38. 7%(94/243). Based on analysis between metastasis group(94 cases) and non-metastasis group( 149 cases), age[(41 ± 10) years old vs(45 ± 12) years old],maximum diameter of tumor[7(1,10)mm vs6(1,10) mm] and multiple foci [44. 7%(42/94) vs 24.2%(36/149)] were related to lymph node metastasis(P = 0.003, 0.002, 0.017); sex, extracapsular spread, MACIS score and AGES score had no significant differences between groups(P = 0. 186, 0. 404, 0. 149, 0. 733)) Receiver operating characteristic curve presented the highest sensitivity and specificity when age was 44. 5 years old and maximum diameter of tumor was 5. 5 mm.Conclusion Age <45 years old, tumor diameter≥6 mm and multiple foci are related to lymph node metastasis.
Objective To explore influence factors of central neck lymph node metastasis of papillary thyroid microcarcinoma( PTMC). Methods A retrospective study was conducted in 243 patients with PTMC who were operated in Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University from March2012 to August 2016. Clinical data including age, sex, tumor size, tumor numbers and extracapsular spread were recorded; MACIS and AGES scoring systems were assessed in all patients; correlation among these factors and central lymph node metastasis was analyzed. Results There were 66 males and 177 females; the lymph node metastasis rate was 38. 7%(94/243). Based on analysis between metastasis group(94 cases) and non-metastasis group( 149 cases), age[(41 ± 10) years old vs(45 ± 12) years old],maximum diameter of tumor[7(1,10)mm vs6(1,10) mm] and multiple foci [44. 7%(42/94) vs 24.2%(36/149)] were related to lymph node metastasis(P = 0.003, 0.002, 0.017); sex, extracapsular spread, MACIS score and AGES score had no significant differences between groups(P = 0. 186, 0. 404, 0. 149, 0. 733)) Receiver operating characteristic curve presented the highest sensitivity and specificity when age was 44. 5 years old and maximum diameter of tumor was 5. 5 mm.Conclusion Age <45 years old, tumor diameter≥6 mm and multiple foci are related to lymph node metastasis.
引文
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[10]李小毅.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:外科部分[J].中国癌症杂志,2016,26(1):13-18.DOI:10.3969/j.issn.1007-3969.2016.01.002.Li XY.The interpretation of 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:surgery part[J].China Oncology,2016,26(1):13-18.DOI:10.3969/j.issn.1007-3969.2016.01.002.
[11]中国抗癌协会甲状腺癌专业委员会.甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版)[J].中国肿瘤临床,2016,43(10):405-411.DOI:10.3969/j.issn.1000-8179.2016.10.001.Chinese Anticancer Association Thyroid Cancer Specialized Committee.Chinese expert consensus on the diagnosis and treatment of papillary thyroid microcarcinoma(2016 edition)[J].Chinese Journal of Clinical Oncology,2016.43(10):405-411.DOI:10.3969/j.issn.1000-8179.2016.10.001.
[12]Park JP,Roh JL,Lee JH,et al.Risk factors for central neck lymph node metastasis of clinically noninvasive,node-negative papillary thyroid microcarcinoma[J].Am J Surg,2014,208(3):412-418.DOI:10.1016/j.amjsurg.2013.10.032.
[13]贺建业,伍冀湘,李华志.甲状腺微小乳头状癌的临床诊疗分析[J].中国医药,2011,6(6):685-687.DOI:10.3760/cma.j.issn.1673-4777.2011.06.023.He JY,Wu JX,Li HZ.Clinical treatment of papillary thyroid microcarcinoma[J].China Medicine,2011,6(6):685-687.DOI:10.3760/cma.j.issn.1673-4777.2011.06.023.
[14]任立军,丁印鲁,张成雷,等.甲状腺微小乳头状癌淋巴结转移规律及手术方式的临床研究[J].中国医药,2011,6(3):309-310.DOI:10.3760/cma.j.issn.1673-4777.2011.03.025.Ren IJ,Ding YL,Zhang CL,et al.Clinical study on the regularity of papillary thyroid microcarcinoma lymph node metastasis and surgical methods[J].China Medicine,2011,6(3):309-310.DOI:10.3760/cma.j.issn.1673-4777.2011.03.025.
[15]Glikson E,Alon E,Bedrin L,et al.Prognostic factors in differentiated thyroid cancer revisited[J].Isr Med Assoc J,2017,19(2):114-118.
[2]Cramer JD,Fu P,Harsh KC,et al.Analysis of the rising incidence of thyroid cancer using the surveillance,epidemiology and end results national cancer data registry[J].Surgery,2010,148(6):1147-1153.DOI:10.1016/j.surg.2010.10.016.
[3]崔凯,赵宇.进展期甲状腺微小乳头状癌预后因素及治疗策略[J].中国医刊,2014,49(1):68-70.DOI:10.3969/j.issn.1008-1070.2014.01.027.Cui K,Zhao Y.Prognostic factors and treatment strategies for progressive thyroid micropapillary carcinoma[J].Chinese Journal of Medicine,2014,49(1):68-70.DOI:10.3969/j.issn.1008-1070.2014.01.027.
[4]Zhang L,Yang J,Sun Q,et al.Risk factors for lymph node metastasis in papillary thyroid microcarcinoma:older patients with fewer lymph node metastases[J].Eur J Surg Oncol,2016,42(10):1478-1482.DOI:10.1016/j.ejso.2016.07.002.
[5]卞雪艳,孙姗姗,郭文宇,等.甲状腺微小乳头状癌颈淋巴结转移的危险因素分析[J].中国肿瘤临床,2015,42(13):658-662.DOI:10.3969/j.issn.1000-8179.20150156.Bian XY,Sun SS,Guo WY,et al.Risk factor analysis for cervical nodal metastasis in papillary microcarcinoma[J].Chinese Journal of Clinical Oncology,2015,42.(13):658-662.DOI:10.3969/j.issn.1000-8179.20150156.
[6]Ito Y,Miyauchi A,Kiharla M,et al.Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation[J].Thyroid,2014,24(1):27-34.DOI:10.1089/thy.2013.0367.
[7]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.DOI:10.1016/j.anl.2015.09.005.
[8]Xue S,Wang P,Liu J,et al.Prophylactic central lymph node dissection in cNO patients with papillary thyroid carcinoma:a retro-speetive study in China[J].Asian J Surg,2016,39(3):131-136.DOI:10.1016/j.asjsur.2015.03.015.
[9]贺建业,侯迎晨,陈东,等.腔镜辅助技术在T1期甲状腺乳头状癌手术中的应用[J].中国微创外科杂志,2014,20(1):25-28.He JY,Hou YC,Chen D,et al.The application of video-assisted technique in the treatment of T1 stage papillary thyroid carcinoma[J].Chinese Journal of Minimally Invasive Surgery,2014,20(1):25-28.
[10]李小毅.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:外科部分[J].中国癌症杂志,2016,26(1):13-18.DOI:10.3969/j.issn.1007-3969.2016.01.002.Li XY.The interpretation of 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:surgery part[J].China Oncology,2016,26(1):13-18.DOI:10.3969/j.issn.1007-3969.2016.01.002.
[11]中国抗癌协会甲状腺癌专业委员会.甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版)[J].中国肿瘤临床,2016,43(10):405-411.DOI:10.3969/j.issn.1000-8179.2016.10.001.Chinese Anticancer Association Thyroid Cancer Specialized Committee.Chinese expert consensus on the diagnosis and treatment of papillary thyroid microcarcinoma(2016 edition)[J].Chinese Journal of Clinical Oncology,2016.43(10):405-411.DOI:10.3969/j.issn.1000-8179.2016.10.001.
[12]Park JP,Roh JL,Lee JH,et al.Risk factors for central neck lymph node metastasis of clinically noninvasive,node-negative papillary thyroid microcarcinoma[J].Am J Surg,2014,208(3):412-418.DOI:10.1016/j.amjsurg.2013.10.032.
[13]贺建业,伍冀湘,李华志.甲状腺微小乳头状癌的临床诊疗分析[J].中国医药,2011,6(6):685-687.DOI:10.3760/cma.j.issn.1673-4777.2011.06.023.He JY,Wu JX,Li HZ.Clinical treatment of papillary thyroid microcarcinoma[J].China Medicine,2011,6(6):685-687.DOI:10.3760/cma.j.issn.1673-4777.2011.06.023.
[14]任立军,丁印鲁,张成雷,等.甲状腺微小乳头状癌淋巴结转移规律及手术方式的临床研究[J].中国医药,2011,6(3):309-310.DOI:10.3760/cma.j.issn.1673-4777.2011.03.025.Ren IJ,Ding YL,Zhang CL,et al.Clinical study on the regularity of papillary thyroid microcarcinoma lymph node metastasis and surgical methods[J].China Medicine,2011,6(3):309-310.DOI:10.3760/cma.j.issn.1673-4777.2011.03.025.
[15]Glikson E,Alon E,Bedrin L,et al.Prognostic factors in differentiated thyroid cancer revisited[J].Isr Med Assoc J,2017,19(2):114-118.