峡部甲状腺微小乳头状癌临床病理分析

doi:10.16139/j.1007-9610.2021.06.014

摘要/Abstract

摘要：

目的：探讨峡部甲状腺微小乳头状癌（papillary thyroid microcarcinoma, PTMC）的临床病理特征。方法：回顾性分析经手术并经病理证实的477例PTMC临床病理资料，比较位于峡部与侧叶PTMC之间的差异。结果：多因素分析显示结节包膜接触（30.5%比10.4%，P=0.001）、淋巴结转移（lymph node metastasis，LNM）（42.7%比18.7%，P<0.001）在峡部与侧叶PTMC之间差异有统计学意义。与侧叶PTMC相比，峡部PTMC更易于出现同侧中央LNM（41.5%比17.5%，P<0.001）、同侧侧方LNM（8.5%比2.8%，P=0.022）和双侧中央LNM（12.2%比0.2%，P<0.001）以及对侧侧方LNM（3.7%比0，P<0.001）。结论：与侧叶PTMC相比，峡部PTMC有更高比例的包膜接触及LNM，建议行双侧中央淋巴结清扫。

关键词: 峡部, 甲状腺微小乳头状癌, 临床病理特征, 淋巴结转移, 中央组

Abstract: Objective To evaluate the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) located in the isthmus. Methods The clinical and pathological data of 477 cases with PTMC diagnosed pathologically were retrospectively analyzed. Differences in PTMC between isthmus and lateral lobe were compared. Results Multivariate analysis showed that there were significantly difference in cancer capsule contact (30.5% vs. 10.4%, P=0.001) and lymph node metastasis (LNM) (42.7% vs. 18.7%, P<0.001) of PTMC between isthmus and lateral lobe. When compared with PTMC in lateral lobe, PTMC in isthmus was more prone to in ipsilateral central LNM (41.5% vs. 17.5%, P<0.001), ipsilateral lateral LNM (8.5% vs. 2.8%, P=0.022) and bilateral central LNM (12.2% vs. 0.2%, P<0.001), and contralateral lateral LNM (3.7% vs. 0, P<0.001). Conclusions PTMC in isthmus had capsular contact and LNM with higher proportion compared with PTMC in lateral lobe. It should suggest bilateral central lymph node dissection for PTMC located in isthmus.

Key words: Isthmus, Papillary thyroid microcarcinoma, Clinicopathological feature, Lymph node metastasis, Central group

中图分类号:

R736.1

樊金芳, 沈依, 詹维伟, 陶玲玲, 李伟伟, 况李君, 周伟. 峡部甲状腺微小乳头状癌临床病理分析[J]. 外科理论与实践, 2021, 26(06): 528-531.

FAN Jinfang, SHEN Yi, ZHAN Weiwei, TAO Lingling, LI Weiwei, KUANG Lijun, ZHOU Wei. Clinicopathological analysis of papillary thyroid microcarcinoma in isthmus[J]. Journal of Surgery Concepts & Practice, 2021, 26(06): 528-531.

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指标	特征	峡部（n=82）	侧叶（n=395）	χ²值	P值
性别	男	19（23.2）	86（21.8）	0.077	0.771
	女	63（76.8）	309（78.2）
年龄（岁）	<45	33（40.2）	170（43.0）	0.217	0.713
	≥45	49（59.8）	225（57.0）
结节最大径（mm）	<5	21（25.6）	91（23.0）	0.250	0.668
	5~10	61（74.4）	304（77.0）
包膜	不接触	57（69.5）	354（89.6）	23.029	<0.001
	接触	25（30.5）	41（10.4）
病理LNM	无转移	47（57.3）	321（81.3）	22.091	<0.001
	转移	35（42.7）	74（18.7）
usLNM	无转移	65（79.3）	355（89.9）	7.258	0.014
	转移	17（20.7）	40（10.1）
合并桥本甲状腺炎	无	64（78.0）	346（87.6）	5.125	0.035
	有	18（22.0）	49（12.4）

指标	回归系数（β）	标准误（SE）	卡方值（Wald）	Df	P值	Exp (β)	95% CI
包膜接触	-1.039	0.315	10.867	1	0.001	0.354	0.191~0.656
病理LNM	-1.287	0.353	13.290	1	<0.001	0.276	0.138~0.552
usLNM	0.150	0.460	0.106	1	0.744	1.162	0.472~2.859
合并桥本甲状腺炎	-0.410	0.350	1.374	1	0.241	0.663	0.334~1.317

LNM	数量和占侧叶 395例百分比	数量和占峡部 82例百分比	χ²值	P值
中央（+）同侧	69（17.5）	34（41.5）	23.092	<0.001
双侧	1（0.2）^a)	10（12.2）	42.983	<0.001
侧方（+）同侧	11（2.8）	7（8.5）	6.187	0.022
对侧	0^a)	3（3.7）^a)	14.543	<0.001