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| 5 mm及以下cN0甲状腺乳头状微小癌中央区淋巴结转移规律及危险因素分析 |
| 于淏1,王强2,查斯洛2,饶文胜2,张伟2,仇明2,单成祥2* |
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(1. 第二军医大学海军医学系学员1队, 上海 200433;
2. 第二军医大学长征医院普外三科, 上海 200003
*通信作者) |
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| 摘要: |
| 目的 探讨肿瘤最大径≤ 5 mm的临床颈部淋巴结阴性（cN0）甲状腺乳头状微小癌（PTMC）患者中央区淋巴结转移（CLNM）的规律及危险因素。方法 纳入2011年1月至2015年12月第二军医大学长征医院普外三科收治的186例肿瘤最大径≤ 5 mm的cN0 PTMC患者，回顾性分析患者的临床病理资料，包括性别、年龄、肿瘤部位、是否双侧癌、是否多灶癌、是否腺外侵犯、是否合并桥本甲状腺炎，以及组织病理免疫组化结果等，总结肿瘤最大径≤ 5 mm的PTMC患者的CLNM规律，并应用χ2检验、多元logistic回归分析其危险因素。结果 186例肿瘤最大径≤ 5 mm的cN0 PTMC患者中，发生CLNM者58例（31.2%）。预防性中央区淋巴结清扫淋巴结个数为0~14个，平均（4.92±6.82）个，其中转移个数为0~5个，平均（0.78±1.41）个；转移淋巴结数目/清扫淋巴结数目百分比为0%~100%，平均（50±28）%。单因素分析结果显示，性别、肿瘤多发灶是肿瘤最大径≤ 5 mm PTMC患者CLNM发生的影响因素（P<0.05）。多因素分析结果显示，男性、肿瘤多发灶均是肿瘤最大径≤ 5 mm的PTMC患者发生CLNM的独立危险因素（P<0.05）。结论 对男性、肿瘤多发灶的最大径≤ 5 mm的cN0 PTMC患者行预防性中央区淋巴结清扫的价值较大。 |
| 关键词: 乳头状甲状腺癌 甲状腺微小癌 中央淋巴结 转移 危险因素 |
| DOI：10.16781/j.0258-879x.2018.01.0101 |
| 投稿时间：2017-06-03修订日期：2017-10-25 |
| 基金项目: |
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| Patterns and risk factors of central lymph node metastasis in cN0 papillary thyroid microcarcinoma with tumor maximum diameter of 5 mm or below |
| YU Hao1,WANG Qiang2,ZHA Si-luo2,RAO Wen-sheng2,ZHANG Wei2,QIU Ming2,SHAN Cheng-xiang2* |
(1. The First Student Team, Faculty of Naval Medicine, Second Military Medical University, Shanghai 200433, China;
2. Department of General Surgery(Ⅲ), Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To investigate the patterns and risk factors of central lymph node metastasis (CLNM) in the clinically node-negative neck (cN0) papillary thyroid microcarcinoma (PTMC) patients with tumor maximum diameter ≤ 5 mm. Methods A total of 186 patients with cN0 PTMC (tumor maximum diameter ≤ 5 mm) were enrolled from Department of General Surgery (Ⅲ), Changzheng Hospital, Second Military Medical University from Jan. 2011 to Dec. 2015. The clinicopathological characteristics of the patients were retrospectively analyzed, including gender, age, tumor location, bilateral carcinoma, multiplicity, extrathyroidal invasion, Hashimoto thyroiditis, and immunohistochemical results. χ2 test and logistic regression were used to evaluate the patterns and risk factors of CLNM in cN0 PTMC patients. Results In this study, 58 (31.2%) of 186 patients with cN0 PTMC (tumor maximum diameter ≤ 5 mm) developed CLNM. The average number of lymph nodes in prophylactic lymph node dissection was 4.92±6.82 (ranged from 0 to 14), with the average number of metastatic lymph nodes being 0.78±1.41 (ranged from 0 to 5). The average ratio of metastatic lymph nodes number/dissected lymphatic nodes number was (50±28)% (ranged from 0% to 100%). Univariate analysis showed that gender and multifocal tumor were risk factors of CLNM (P<0.05). Multivariate analysis showed that male and multifocal tumor were independent risk factors of CLMM in PTMC (tumor maximum diameter ≤ 5 mm) patients (P<0.05). Conclusion Prophylactic central lymph node dissection may be more valuable for male cN0 PTMC (tumor maximum diameter ≤ 5 mm) patients with multifocal tumors. |
| Key words: papillary thyroid carcinoma thyroid microcarcinoma central lymph node metastasis risk factor |
