甲状腺乳头状癌颈侧区淋巴结转移相关影响因素分析
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摘要
目的分析甲状腺乳头状癌(PTC)颈侧区淋巴结转移(LLNM)的影响因素,进一步探讨超声对LLNM的诊断价值。方法回顾性分析2017-01～2017-12经病理及超声资料证实的PTC患者179例,根据有无颈侧区淋巴结转移分为转移组(97例)与非转移组(82例)。分析总结两组的临床及超声特征,应用χ2检验、t检验和多因素Logistic回归分析进行颈侧区淋巴结转移的危险因素分析。结果①单因素分析显示:两组间患者性别(P=0. 002)、肿瘤直径(P <0. 001)、中央区淋巴结转移(P <0. 001)、多灶性(P=0. 048)、被膜侵犯(P=0. 006)、原发灶内微钙化(P <0. 001)、结节纵横比> 1(P=0. 017)比较差异有统计学意义。②多因素Logistic回归分析显示:患者性别、肿瘤直径、中央区淋巴结转移、被膜侵犯、原发灶内微钙化为PTC颈侧区淋巴结转移的独立危险因素。结论男性、肿瘤直径≥1. 1 cm、中央区淋巴结转移、被膜侵犯、原发灶内微钙化与LLNM相关,当超声发现甲状腺可疑恶性病灶并伴有以上超声征象及临床特征时,应仔细扫查颈侧区淋巴结。
Objective To analyze related factors for lateral lymph node metastasis( LLNM) in papillary thyroid carcinoma( PTC),and to further explore the diagnostic value of ultrasonography in LLNM. Methods The clinical data of 179 cases of PTC confirmed by pathology and ultrasound were analyzed retrospectively. According to presence of lateral lymph node metastasis,they were divided into metastasis group( n = 97) and non-metastasis group( n = 82). The clinical and sonographic features were made to analyzed and summarized in the two groups. Chi-square test/t test and the multi-factor Logistic regression analysis were used to analyze the risk factors.Results ①The single factor analysis showed that the patient gender( P = 0. 002),tumor diameter( P < 0. 001),central lymph node metastasis( P < 0. 001),multifocality( P = 0. 048),extra thyroidal extension( P = 0. 006),microcalcification( P < 0. 001),height/width ratio > 1( P = 0. 017) were statistically different between the two groups. ②Multivariable Logistic regression analysis showed that patient gender,tumor diameter,central lymph node metastasis,extra thyroidal extension,microcalcification were independent risk factors for PTC LLNM. Conclusion Lateral lymph node metastasis is significantly associated with male,tumor diameter≥1. 1 cm,central lymph node metastasis,extra thyroidal extension,microcalcification. When ultrasound shows a suspected malignant thyroid lesion with the above ultrasound signs and clinical features,the lateral lymph nodes should be scanned carefully.
Objective To analyze related factors for lateral lymph node metastasis( LLNM) in papillary thyroid carcinoma( PTC),and to further explore the diagnostic value of ultrasonography in LLNM. Methods The clinical data of 179 cases of PTC confirmed by pathology and ultrasound were analyzed retrospectively. According to presence of lateral lymph node metastasis,they were divided into metastasis group( n = 97) and non-metastasis group( n = 82). The clinical and sonographic features were made to analyzed and summarized in the two groups. Chi-square test/t test and the multi-factor Logistic regression analysis were used to analyze the risk factors.Results ①The single factor analysis showed that the patient gender( P = 0. 002),tumor diameter( P < 0. 001),central lymph node metastasis( P < 0. 001),multifocality( P = 0. 048),extra thyroidal extension( P = 0. 006),microcalcification( P < 0. 001),height/width ratio > 1( P = 0. 017) were statistically different between the two groups. ②Multivariable Logistic regression analysis showed that patient gender,tumor diameter,central lymph node metastasis,extra thyroidal extension,microcalcification were independent risk factors for PTC LLNM. Conclusion Lateral lymph node metastasis is significantly associated with male,tumor diameter≥1. 1 cm,central lymph node metastasis,extra thyroidal extension,microcalcification. When ultrasound shows a suspected malignant thyroid lesion with the above ultrasound signs and clinical features,the lateral lymph nodes should be scanned carefully.
引文
[1]王亮,吴长华,邹淑娟,等.甲状腺乳头状癌颈侧区淋巴结转移的影响因素[J].国际肿瘤学杂志,2016,43(3):207-209.
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[3]张晓晓,詹维伟,周伟,等.术前超声检查评估甲状腺微小乳头状癌颈部淋巴结转移的临床价值[J].中华医学超声杂志:电子版,2014,11(11):52-56.
[4]黄丽燕,何以敉,薛恩生,等.超声对甲状腺癌颈部转移性淋巴结区域及特点的评价[J].中华超声影像学杂志,2014,23(9):769-772.
[5] Haugen BR,Alexander EK,Bible KC,et al. 2015 AmericanThyroid Association management guidelines for adult patients withthyroid nodules and differentiated thyroid cancer:the AmericanThyroid Association guidelines task force on thyroid nodules anddifferentiated thyroid cancer[J]. Thyroid,2016,26(1):1-133.
[6] Nam IC,Park JO,Joo YH,et al. Pattern and predictive factorsof regional lymph node metastasis in papillary thyroid carcinoma:A prospective study[J]. Head Neck,2013,35(1):40-45.
[7] Ito Y,Higashiyama T,Takamura Y,et al. Risk factors for re-currence to the lymph node in papillary thyroid carcinoma patientswithout preoperatively detectable lateral node metastasis:validityof prophylactic modified radical neck dissection[J]. World JSurg,2007,31(11):2085-2091.
[8]陈锐,魏涛,张明,等.甲状腺乳头状癌c N0患者颈侧区淋巴结转移规律的探讨[J].中华耳鼻咽喉头颈外科杂志,2012,47(8):662-667.
[9]王文涵,詹维伟,徐上妍,等.甲状腺微小乳头状癌的超声特征与颈部淋巴结转移的关系[J].中华超声影像学杂志,2014,23(3):231-234.
[10]曾瑞超,李权,吕超,等.甲状腺微小乳头状癌超声特征与预测颈侧区淋巴结转移关系的探讨[J].中华超声影像学杂志,2012,21(2):146-148.
[11]张强,张仑,宋方方,等.甲状腺乳头状癌颈部淋巴结转移规律临床分析[J].中国耳鼻咽喉头颈外科,2010,17(12):639-642.
[12] Xiao GZ,Gao L. Central lymph node metastasis:is it a reliableindicator of lateral node involvement in papillary thyroid carcino-ma[J]. World J Surg,2010,34(2):237.
[13] Girardi FM,Barra MB,Zettler CG. Predictive Factors for LymphNode Metastasis in Solitary Papillary Thyroid Carcinomas:A Ret-rospective Study[J]. Pathol Oncol Res,2015,21(1):59-64.
[14] Liu Z,Lei J,Liu Y,et al. Preoperative predictors of lateral necklymph node metastasis in papillary thyroid microcarcinoma[J].Medicine,2017,96(10):e6240.
[15] He LZ,Zeng TS,Pu L,et al. Thyroid hormones,autoantibod-ies,ultrasonography,and clinical parameters for predicting thy-roid cancer[J]. Int J Endocrinol,2016,2016(3):1-11.
[16] Li C,Yu W,Fan J,et al. Thyroid functional parameters andcorrelative autoantibodies as prognostic factors for differentiatedthyroid cancers[J]. Oncotarget,2016,7(31):49930-49938.
[17] Kim SS,Lee BJ,Lee JC,et al. Preoperative serum thyroid stim-ulating hormone levels in well-differentiated thyroid carcinoma isa predictive factor for lateral lymph node metastasis as well as ex-trathyroidal extension in Korean patients:a single-center experi-ence[J]. Endocrine,2011,39(3):259-265.
[18] Han SL,Jung EJ,Ju YK,et al. Lateral Lymph Node MetastasisPrediction in Papillary Thyroid Cancer Patients with SuspiciousPreoperative Imaging Findings[J]. Korean J Endocr Surg,2016,16:6-12.
[2] Pomorski L. Cervical lymph node surgery in differentiated thyroidcancer:selective or elective lymphadenectomy[J]. Wiad Lek,2001,54(suppl 1):198-204.
[3]张晓晓,詹维伟,周伟,等.术前超声检查评估甲状腺微小乳头状癌颈部淋巴结转移的临床价值[J].中华医学超声杂志:电子版,2014,11(11):52-56.
[4]黄丽燕,何以敉,薛恩生,等.超声对甲状腺癌颈部转移性淋巴结区域及特点的评价[J].中华超声影像学杂志,2014,23(9):769-772.
[5] Haugen BR,Alexander EK,Bible KC,et al. 2015 AmericanThyroid Association management guidelines for adult patients withthyroid nodules and differentiated thyroid cancer:the AmericanThyroid Association guidelines task force on thyroid nodules anddifferentiated thyroid cancer[J]. Thyroid,2016,26(1):1-133.
[6] Nam IC,Park JO,Joo YH,et al. Pattern and predictive factorsof regional lymph node metastasis in papillary thyroid carcinoma:A prospective study[J]. Head Neck,2013,35(1):40-45.
[7] Ito Y,Higashiyama T,Takamura Y,et al. Risk factors for re-currence to the lymph node in papillary thyroid carcinoma patientswithout preoperatively detectable lateral node metastasis:validityof prophylactic modified radical neck dissection[J]. World JSurg,2007,31(11):2085-2091.
[8]陈锐,魏涛,张明,等.甲状腺乳头状癌c N0患者颈侧区淋巴结转移规律的探讨[J].中华耳鼻咽喉头颈外科杂志,2012,47(8):662-667.
[9]王文涵,詹维伟,徐上妍,等.甲状腺微小乳头状癌的超声特征与颈部淋巴结转移的关系[J].中华超声影像学杂志,2014,23(3):231-234.
[10]曾瑞超,李权,吕超,等.甲状腺微小乳头状癌超声特征与预测颈侧区淋巴结转移关系的探讨[J].中华超声影像学杂志,2012,21(2):146-148.
[11]张强,张仑,宋方方,等.甲状腺乳头状癌颈部淋巴结转移规律临床分析[J].中国耳鼻咽喉头颈外科,2010,17(12):639-642.
[12] Xiao GZ,Gao L. Central lymph node metastasis:is it a reliableindicator of lateral node involvement in papillary thyroid carcino-ma[J]. World J Surg,2010,34(2):237.
[13] Girardi FM,Barra MB,Zettler CG. Predictive Factors for LymphNode Metastasis in Solitary Papillary Thyroid Carcinomas:A Ret-rospective Study[J]. Pathol Oncol Res,2015,21(1):59-64.
[14] Liu Z,Lei J,Liu Y,et al. Preoperative predictors of lateral necklymph node metastasis in papillary thyroid microcarcinoma[J].Medicine,2017,96(10):e6240.
[15] He LZ,Zeng TS,Pu L,et al. Thyroid hormones,autoantibod-ies,ultrasonography,and clinical parameters for predicting thy-roid cancer[J]. Int J Endocrinol,2016,2016(3):1-11.
[16] Li C,Yu W,Fan J,et al. Thyroid functional parameters andcorrelative autoantibodies as prognostic factors for differentiatedthyroid cancers[J]. Oncotarget,2016,7(31):49930-49938.
[17] Kim SS,Lee BJ,Lee JC,et al. Preoperative serum thyroid stim-ulating hormone levels in well-differentiated thyroid carcinoma isa predictive factor for lateral lymph node metastasis as well as ex-trathyroidal extension in Korean patients:a single-center experi-ence[J]. Endocrine,2011,39(3):259-265.
[18] Han SL,Jung EJ,Ju YK,et al. Lateral Lymph Node MetastasisPrediction in Papillary Thyroid Cancer Patients with SuspiciousPreoperative Imaging Findings[J]. Korean J Endocr Surg,2016,16:6-12.