cN0期甲状腺微小乳头状癌侧颈淋巴结转移危险因素分析
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摘要
目的:探讨甲状腺微小乳头状癌(PTMC)患者侧颈区淋巴结转移的危险因素。方法:回顾性分析462例临床淋巴结阴性(cN0)的PTMC患者的术前彩超及临床病理资料,应用χ~2检验和多因素Logistic回归分析侧颈区淋巴结转移危险因素。结果:全组患者中PTMC中央区淋巴结转移率为38.5%,侧颈区淋巴结转移率为23.6%。单因素分析显示,性别(χ~2=7.312,P<0.05)、肿瘤直径(χ~2=14.321,P<0.001)、包膜受侵(χ~2=21.689,P<0.001)、多灶癌(χ~2=13.086,P<0.001)、中央区淋巴结阳性(χ~2=69.421,P<0.001)、肿瘤位置(χ~2=19.028,P<0.001)与侧颈区淋巴结转移明显有关;多因素Logistic回归分析显示,男性(OR=1.758)、肿瘤直径≥7mm(OR=1.710)、包膜受侵(OR=3.337)、多灶(OR=1.778)、中央区淋巴结阳性(OR=7.504)、肿瘤位于上极(OR=4.084)是PTMC患者侧颈区淋巴结转移的独立危险因素(均P<0.05)。侧颈区淋巴结的转移风险随中央区淋巴结转移数目的增多而增加(≥3枚:OR=19.957)。结论:cN0期PTMC的侧颈淋巴结转移与多个因素有关,对于存在这些危险因素的患者,首次手术治疗时应考虑行患侧侧颈区淋巴结探查。
Objective: To investigate the risk factors of lateral neck lymph node metastasis in patients with papillary thyroid microcarcinoma(PTMC). Methods: The preoperative color Doppler results and clinicopathologic data of 462 patients with clinical lymph node negative(cN0) PTMC were retrospectively analyzed. The risk factors for lateral neck lymph node metastasis were determined by χ~2 test and Logistic regression analysis. Results: In the entire group of patients, the rate of central neck lymph node metastasis was 38.5% and the rate of lateral neck lymph node metastasis was 23.6%. The results of univariate analysis showed that sex(χ~2=7.312, P<0.05), tumor diameter(χ~2=14.321, P<0.001), thyroid capsule invasion(χ~2=21.689, P<0.001), multiple tumors(χ~2=13.086, P<0.001), tumor location(χ~2=19.028, P<0.001) and central neck lymph node metastasis(χ~2=69.421, P<0.001) were significantly associated with lateral lymph node metastasis. The results of multivariate Logistic regression analysis indicated that male sex(OR=1.758), tumor diameter ≥7 mm(OR=1.710), thyroid capsule invasion(OR=3.337), multiple tumors(OR=1.778), central neck lymph node metastasis(OR=7.504) and tumor in the superior pole(OR=4.084) were independent risk factors for lateral neck lymph node metastasis(all P<0.05). The risk of lateral neck lymph node metastasis was increased with the increase of the number of affected central neck lymph nodes(≥3: OR=19.957).Conclusion: In patients with cN0 PTMC, lateral lymph node metastasis is related to a number of factors. For those who have one or more of them, lateral neck lymph node exploration of the affected side is recommended in the first surgery.
Objective: To investigate the risk factors of lateral neck lymph node metastasis in patients with papillary thyroid microcarcinoma(PTMC). Methods: The preoperative color Doppler results and clinicopathologic data of 462 patients with clinical lymph node negative(cN0) PTMC were retrospectively analyzed. The risk factors for lateral neck lymph node metastasis were determined by χ~2 test and Logistic regression analysis. Results: In the entire group of patients, the rate of central neck lymph node metastasis was 38.5% and the rate of lateral neck lymph node metastasis was 23.6%. The results of univariate analysis showed that sex(χ~2=7.312, P<0.05), tumor diameter(χ~2=14.321, P<0.001), thyroid capsule invasion(χ~2=21.689, P<0.001), multiple tumors(χ~2=13.086, P<0.001), tumor location(χ~2=19.028, P<0.001) and central neck lymph node metastasis(χ~2=69.421, P<0.001) were significantly associated with lateral lymph node metastasis. The results of multivariate Logistic regression analysis indicated that male sex(OR=1.758), tumor diameter ≥7 mm(OR=1.710), thyroid capsule invasion(OR=3.337), multiple tumors(OR=1.778), central neck lymph node metastasis(OR=7.504) and tumor in the superior pole(OR=4.084) were independent risk factors for lateral neck lymph node metastasis(all P<0.05). The risk of lateral neck lymph node metastasis was increased with the increase of the number of affected central neck lymph nodes(≥3: OR=19.957).Conclusion: In patients with cN0 PTMC, lateral lymph node metastasis is related to a number of factors. For those who have one or more of them, lateral neck lymph node exploration of the affected side is recommended in the first surgery.
引文
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[3]Brito JP,Al Nofal A,Montori VM,et al.The Impact of Subclinical Disease and Mechanism of Detection on the Rise in Thyroid Cancer Incidence:A Population-Based Study in Olmsted County,Minnesota During 1935 Through 2012[J].Thyroid,2015,25(9):999-1007.doi:10.1089/thy.2014.0594.
[4]Zhang L,Wei WJ,Ji QH,et al.Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma:a studyof 1066patients[J].J Clin Endocrinol Metab,2012,97(4):1250-1257.doi:10.1210/jc.2011-1546.
[5]Mao LN,Wang P,Li ZY,et al.Risk factor analysis for central nodal metastasis in papillary thyroid carcinoma[J].Oncol Lett,2015,9(1):103-107.doi:10.3892/ol.2014.2667.
[6]沈文亮,黑虎,龚文博,等.甲状腺微小乳头状癌中央区淋巴结转移相关因素分析[J].中华内分泌外科杂志,2018,12(1):30-33.doi:10.3760/cma.j.issn.1674-6090.2018.01.008.Shen WL,Hei H,Gong WB,et al.Related factors of central regional lymph node metastasis in thyroid papillary microcarcinoma[J].Journal of Endocrine Surgery,2018,12(1):30-33.doi:10.3760/cma.j.issn.1674-6090.2018.01.008.
[7]Roh JL,Kim JM,Park CI.Lateral cervical lymph node metastases from papillary thyroid carcinoma:pattern of nodal metastases and optimal strategy for neck dissection[J].Ann Surg Oncol,2008,15(4):1177-1182.doi:10.1245/s10434-008-9813-5.
[8]Haugen BR,Alexander EK,Bible KC,et al.2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer:The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J].Thyroid,2016,26(1):1-133.doi:10.1089/thy.2015.0020.
[9]中国医师协会外科医师分会甲状腺外科医师委员会,中国研究型医院学会甲状腺疾病专业委员会.分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版)[J].中国实用外科杂志,2017,37(9):985-991.doi:10.19538/j.cjps.issn1005-2208.2017.09.13.Chinese Thyroid Association,Committee of Thyroid Surgeon of Chinese Research Hospital Association.Expert consensus on lateral neck lymph node dissection in differentiated thyroid carcinoma(2017 edition)[J].Chinese Journal of Practical Surgery,2017,37(9):985-991.doi:10.19538/j.cjps.issn1005-2208.2017.09.13.
[10]Kupferman ME,Patterson M,Mandel SJ,et al.Patterns of lateral neck metastasis in papillary thyroid carcinoma[J].Arch Otolaryngol Head Neck Surg,2004,130(7):857-860.doi:10.1001/archotol.130.7.857
[11]Uchida H,Imai T,Kikumori T,et al.Long-term results of surgery for papillary thyroid carcinoma with local recurrence[J].Surg Today,2013,43(8):848-853.doi:10.1007/s00595-012-0353-z.
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[15]Lim YC,Choi EC,Yoon YH,et al.Central lymph node metastases in unilateral papillary thyroid microcarcinoma[J].Br J Surg,2009,96(3):253-257.doi:10.1002/bjs.6484.
[16]石岚,黄韬.甲状腺乳头状癌淋巴结转移规律的研究[J].中华普通外科杂志,2007,22(7):524-526.doi:10.3760/j.issn:1007-631X.2007.07.014.Shi L,Huang T.A study on the cervical lymph node metastases of papillary thyroid cancer[J].Zhong Hua Pu Tong Wai Ke Za Zhi,2007,22(7):524-526.doi:10.3760/j.issn:1007-631X.2007.07.014.
[17]樊友本,伍波,郭顺利,等.复发性甲状腺乳头状癌的再次手术[J].中华内分泌外科杂志,2009,3(1):25-26.doi:10.3760/cma.j.issn.1674-6090.2009.01.009.Fan YB,Wu B,Guo SL,et al.Reoperation of papillary thyroid carcinoma[J].Journal of Endocrine Surgery,2009,3(1):25-26.doi:10.3760/cma.j.issn.1674-6090.2009.01.009.
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[19]李宇杰,黄小娥,周小栋.预防性中央区淋巴结清扫与甲状腺乳头状癌局部复发的Meta分析[J].中国普通外科杂志,2013,22(5):608-612.doi:10.7659/j.issn.1005-6947.2013.05.016.Li YJ,Huang XE,Zhou XD.Prophylactic central neck dissection and local recurrence in papillary thyroid cancer:a Meta-analysis[J].Chinese Journal of General Surgery,22013,22(5):608-612.doi:10.7659/j.issn.1005-6947.2013.05.016.
[20]李思齐,李燕,张毅,等.甲状腺乳头状癌术中喉前及气管前淋巴结联合冷冻病理检测的临床价值[J].中国普通外科杂志,2018,27(11):1387-1392.doi:10.7659/j.issn.1005-6947.2018.11.004.Li SQ,Li Y,Zhang Y,et al.Clinical value of intraoperative frozen section analysis for prelaryngeal and pretracheal lymph nodes in surgery for papillary thyroid carcinoma[J].Chinese Journal of General Surgery,2018,27(11):1387-1392.doi:10.7659/j.issn.1005-6947.2018.11.004.
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