甲状腺微小乳头状癌中央区淋巴结转移的相关因素分析
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摘要
目的回顾性分析甲状腺微小乳头状癌(PTMC)患者的临床资料,探讨PTMC患者发生中央区淋巴结转移(CLNM)的相关因素,为预防性中央组淋巴结清扫提供临床依据。方法纳入2013年1月—2016年6月蚌埠医学院第一附属医院肿瘤外科手术治疗并病理证实为PTMC的254例患者,按有无CLNM分成转移组和无转移组。收集患者临床资料,分析年龄、性别、癌灶数、病灶直径、术前超声提示微钙化和肿大淋巴结情况与PTMC患者发生CLNM的相关性。结果 254例PTMC患者中77例发生CLNM,发生率为30.3%。分析显示男性、年龄<45岁、病灶最大径≥5 mm、多发病灶及术前超声提示淋巴结肿大的PTMC患者CLNM发生率明显高于女性、年龄≥45岁、病灶最大径<5 mm、单发病灶及无淋巴结肿大患者(均P<0.05)。分析显示术前超声提示有微钙化的PTMC患者CLNM发生率与无微钙化患者相当,差异无统计学意义(P>0.05)。多因素Logistic回归分析显示男性、原发病灶直径≥5 mm、多发病灶及术前超声提示颈部淋巴结肿大是PTMC患者颈部中央区淋巴结转移的独立危险因素(均P<0.05)。结论 PTMC患者为男性、年龄<45岁、病灶最大径≥5 mm、多发病灶及术前颈部超声提示淋巴结肿大的更易发生CLNM。其中男性、原发病灶直径≥5 mm、多发病灶及术前超声提示颈部淋巴结肿大PTMC患者颈部中央区淋巴结转移的独立危险因素。
Objective To analyze the clinical characteristics of patients with papillary thyroid microcarcinoma( PTMC),and explore risk factors of central lymph node metastasis( CLNM) in patients with PTMC. Methods A total of 254 patients with PTMC from January,2013 to June,2016 were analyzed retrospectively,all subjects underwent central compartment lymph node dissection. The patients were assigned into positive group and negative group according to the CLNM. The risk factors for CLNM were analyzed with respect to sex,age,tumor size,tumor multifocal,microcalcification,lymphadenectasis of lateral neck. Results Among the 254 patients,the CLNM occurred in 77 patients(30. 3%).The univariate analyses showed that gender of male,age of < 45 years,tumor diameter ≥5 mm,multifocality and lymphadenectasis of lateral neck significantly increased the risk of CLNM( all P < 0. 05). Nevertheless,the microcalcification was not significantly related to the presence of CLNM( P > 0. 05). Multivariate analysis showed that gender of male,tumor diameter ≥ 5 mm multifocality,and lymphadenectasis of lateral neck were independent risk factors for central lymph node metastasis( all P < 0. 05). Conclusion The gender of male,age of < 45 year,tumor diameter ≥5 mm,multifocality and lymphadenectasis of lateral neck are associated with CLNM in PTMC patients. The male patients with primary lesions ≥5 mm in diameter,multiple lesions and preoperative ultrasound findings of cervical lymphadenopathy are the independent risk factors for CLNM in patients with PTMC.
Objective To analyze the clinical characteristics of patients with papillary thyroid microcarcinoma( PTMC),and explore risk factors of central lymph node metastasis( CLNM) in patients with PTMC. Methods A total of 254 patients with PTMC from January,2013 to June,2016 were analyzed retrospectively,all subjects underwent central compartment lymph node dissection. The patients were assigned into positive group and negative group according to the CLNM. The risk factors for CLNM were analyzed with respect to sex,age,tumor size,tumor multifocal,microcalcification,lymphadenectasis of lateral neck. Results Among the 254 patients,the CLNM occurred in 77 patients(30. 3%).The univariate analyses showed that gender of male,age of < 45 years,tumor diameter ≥5 mm,multifocality and lymphadenectasis of lateral neck significantly increased the risk of CLNM( all P < 0. 05). Nevertheless,the microcalcification was not significantly related to the presence of CLNM( P > 0. 05). Multivariate analysis showed that gender of male,tumor diameter ≥ 5 mm multifocality,and lymphadenectasis of lateral neck were independent risk factors for central lymph node metastasis( all P < 0. 05). Conclusion The gender of male,age of < 45 year,tumor diameter ≥5 mm,multifocality and lymphadenectasis of lateral neck are associated with CLNM in PTMC patients. The male patients with primary lesions ≥5 mm in diameter,multiple lesions and preoperative ultrasound findings of cervical lymphadenopathy are the independent risk factors for CLNM in patients with PTMC.
引文
[1]Siegel R,Naishadham D,Jemal A.Cancer statistics for Hispanics/Latinos,2012[J].CA Cancer J Clin,2015,65(6):283-298.
[2]Arem R,Padayatty SJ,Saliby AH,et al.Thyroid microcarcinoma:prevalence,prognosis,and management[J].Endocr Pract,1999,5(3):148-156.
[3]Ahn HS,Kim HJ,Welch HG.Korea’s thyroid-cancer“epidemic”:screening and overdiagnosis[J].N Engl J Med,2014,371(19):1765-1767.
[4]Davies L,Welch HG.Increasing incidence of thyroid cancer in the United States,1973-2002[J].JAMA,2006,295(18):2164-2167.
[5]So YK,Kim MJ,Kim S,et al.Lateral lymph node metastasis in papillary thyroid carcinoma:A systematic review and meta-analysis for prevalence,risk factors,and location[J].Int J Surg,2018,50:94-103.
[6]Haugen BR,Alexander EK,Bible KC,et al.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,2015,26(1):1-133.
[7]中华医学会内分泌学分会,中华医学会外科学分会内分泌外科学组,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.
[8]王卓颖.甲状腺微小癌中央区淋巴结清扫临床价值[J].中国实用外科杂志,2016,36(5):508-511.
[9]Gui CY,Qiu SL,Peng ZH,et al.Clinical and pathologic predictors of central lymph node metastasis in papillary thyroidmicrocarcinoma:a retrospective cohort study[J].J Endocrinol Invest,2018,41(4):403-409.
[10]Liu LS,Liang J,Li JH,et al.The incidence and risk factors for central lymph nodemetastasisinc N0papillary thyroidmicrocarcinoma:a meta-analysis[J].Eur Arch Otorhinolaryngol,2017,274(3):1327-1338.
[11]Siddiqui S,White MG,Antic T,et al.Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma[J].Thyroid,2016,26(6):807-815.
[12]彭琛,魏松锋,郑向前,等.1401例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析[J].中国肿瘤临床,2016,43(3):95-99.
[13]高庆军,王南鹏,赵代伟.c N0期甲状腺乳头状微小癌中央区淋巴结隐性转移危险因素[J].中国普通外科杂志,2015,24(11):1504-1510.
[14]Akin S,Yazgan AD,Akin S,et al.Prediction of central lymph node metastasis in patientswith thyroid papillary microcarcinoma[J].Turk J Med Sci,2017,47(6):1723-1727.
[15]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.
[16]Zhao C,Jiang W,Gao Y,et al.Risk factors for lymph node metastasis(LNM)in patients with papillary thyroid microcarcinoma(PTMC):role of preoperative ultrasound[J].J Int Med Res,2017,45(3):1221-1230.
[17]Lee YC,Eun YG,Sohn YM,et al.Predictive factors for occult contralateral carcinomain patients with unilateral papillary thyroid microcarcinoma by preoperative ultrasonographic and pathological features[J].World J Surg,2015,39(7):1736-1741.
[18]Li RQ,Yuan GH,Chen M,et al.Evaluation of Diagnostic Efficiency of Ultrasound Features on Malignant Thyroid Nodules in Chinese Patients[J].Chin Med J(Engl),2016,129(15):1784-1788.
[2]Arem R,Padayatty SJ,Saliby AH,et al.Thyroid microcarcinoma:prevalence,prognosis,and management[J].Endocr Pract,1999,5(3):148-156.
[3]Ahn HS,Kim HJ,Welch HG.Korea’s thyroid-cancer“epidemic”:screening and overdiagnosis[J].N Engl J Med,2014,371(19):1765-1767.
[4]Davies L,Welch HG.Increasing incidence of thyroid cancer in the United States,1973-2002[J].JAMA,2006,295(18):2164-2167.
[5]So YK,Kim MJ,Kim S,et al.Lateral lymph node metastasis in papillary thyroid carcinoma:A systematic review and meta-analysis for prevalence,risk factors,and location[J].Int J Surg,2018,50:94-103.
[6]Haugen BR,Alexander EK,Bible KC,et al.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,2015,26(1):1-133.
[7]中华医学会内分泌学分会,中华医学会外科学分会内分泌外科学组,中国抗癌协会头颈肿瘤专业委员会,等.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.
[8]王卓颖.甲状腺微小癌中央区淋巴结清扫临床价值[J].中国实用外科杂志,2016,36(5):508-511.
[9]Gui CY,Qiu SL,Peng ZH,et al.Clinical and pathologic predictors of central lymph node metastasis in papillary thyroidmicrocarcinoma:a retrospective cohort study[J].J Endocrinol Invest,2018,41(4):403-409.
[10]Liu LS,Liang J,Li JH,et al.The incidence and risk factors for central lymph nodemetastasisinc N0papillary thyroidmicrocarcinoma:a meta-analysis[J].Eur Arch Otorhinolaryngol,2017,274(3):1327-1338.
[11]Siddiqui S,White MG,Antic T,et al.Clinical and Pathologic Predictors of Lymph Node Metastasis and Recurrence in Papillary Thyroid Microcarcinoma[J].Thyroid,2016,26(6):807-815.
[12]彭琛,魏松锋,郑向前,等.1401例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析[J].中国肿瘤临床,2016,43(3):95-99.
[13]高庆军,王南鹏,赵代伟.c N0期甲状腺乳头状微小癌中央区淋巴结隐性转移危险因素[J].中国普通外科杂志,2015,24(11):1504-1510.
[14]Akin S,Yazgan AD,Akin S,et al.Prediction of central lymph node metastasis in patientswith thyroid papillary microcarcinoma[J].Turk J Med Sci,2017,47(6):1723-1727.
[15]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.
[16]Zhao C,Jiang W,Gao Y,et al.Risk factors for lymph node metastasis(LNM)in patients with papillary thyroid microcarcinoma(PTMC):role of preoperative ultrasound[J].J Int Med Res,2017,45(3):1221-1230.
[17]Lee YC,Eun YG,Sohn YM,et al.Predictive factors for occult contralateral carcinomain patients with unilateral papillary thyroid microcarcinoma by preoperative ultrasonographic and pathological features[J].World J Surg,2015,39(7):1736-1741.
[18]Li RQ,Yuan GH,Chen M,et al.Evaluation of Diagnostic Efficiency of Ultrasound Features on Malignant Thyroid Nodules in Chinese Patients[J].Chin Med J(Engl),2016,129(15):1784-1788.