甲状腺乳头状癌颈部淋巴结转移的危险因素分析

doi:10.16139/j.1007-9610.2022.01.017

摘要/Abstract

摘要：

目的:分析影响甲状腺乳头状癌颈部淋巴结转移的临床特征,探讨颈部淋巴结转移发生的危险因素。方法:对2019年1月至2020年12月上海国际医学中心收治203例甲状腺乳头状癌病人的临床资料行回顾性分析,对可能影响颈部淋巴结转移的相关因素行单因素及多因素Logistic回归分析。结果:203例中,淋巴结转移率44.3%（90例）,颈侧区淋巴结转移率为4.9%（10例）。单因素分析提示,男性、超声检查显示钙化、大病灶、多灶性、肿瘤贴近包膜、超重病人的颈部淋巴结转移率较高（P<0.05）。多因素分析提示,男性、<45岁、大病灶、多灶性、肿瘤贴近包膜是颈部淋巴结转移的独立危险因素。颈侧区淋巴结转移的病例中,肿瘤位于上极者较多。结论:男性,<45岁、大病灶、多灶性、肿瘤贴近包膜为甲状腺乳头状癌颈部淋巴结转移的危险因素。建议重视术前颈部淋巴结评估和术中探查。

关键词: 甲状腺乳头状癌, 颈部淋巴结转移, 钙化

Abstract:

Objective To study the clinical characteristics of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC) and to explore the risk factors of nodal metastasis. Methods A retrospective analysis of the clinical data of 203 patients with PTC was conducted from January 2019 to December 2020 in Shanghai International Medical Center. The factors influencing cervical lymph node metastasis were analyzed by univariate analysis and multivariate Logistic regression. Results Rate of lymph node metastasis in 203 patients was 44.3% (90 cases) and 4.9% (10 cases) in la-teral compartment. Univariate analysis showed that rate of cervical lymph node metastasis was higher in males, thyroid calcification on ultrasonography, larger tumor, multifocus, tumor close to capsule, and the cases with overweight (P<0.05). Multivariate analysis showed that male, age younger than 45 years, larger tumor, multifocus, and tumor close to the capsule were independent risk factors of cervical lymph node metastasis. Tumor was more located in the upper thyroid pole for the patients with lateral lymph node metastasis. Conclusions Male, age younger than 45 years, larger tumor, multifocus, and tumor close to capsule would be risk factors for cervical lymph node metastasis in PTC. It is recommended to pay more attention to both preoperative evaluation and intraoperative exploration for cervical lymph nodes.

Key words: Papillary thyroid carcinoma, Cervical lymph node metastasis, Calcification

中图分类号:

R736.1

刘荣耀, 李祥翠, 王丽娜, 陈海珍. 甲状腺乳头状癌颈部淋巴结转移的危险因素分析[J]. 外科理论与实践, 2022, 27(01): 76-79.

LIU Rongyao, LI Xiangcui, WANG Lina, CHEN Haizhen. Analysis of risk factors for cervical lymph node metastasis in papillary thyroid carcinoma[J]. Journal of Surgery Concepts & Practice, 2022, 27(01): 76-79.

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项目	总例数	转移例数	发生率（%）	χ²值	P值	标化残差^a)
性别
男	53	33	62.3	9.343	0.002^b)
女	150	57	38.0
年龄（岁）
<45	149	72	48.3	3.608	0.057
≥45	54	18	33.3
钙化
是	149	76	51.0	10.103	0.001^b)
否	54	14	25.9
病灶数
单发	150	58	38.7	7.480	0.006^b)
多发	53	32	60.4
肿瘤直径（cm）
0.1~0.4	52	10	19.2	26.1	<0.001^b)	-4.2
0.5~0.9	104	47	45.2			0.3
≥1.0	47	33	70.2			4.1
合并结节性甲状腺肿
是	35	11	31.4	2.855	0.091
否	168	79	47.0
合并桥本甲状腺炎
是	74	31	41.9	0.282	0.596
否	129	59	45.7
体质量指数（kg/m²）
18.5~23.9	111	42	37.8	6.597	0.037^b)	-2.0
>23.9	75	42	56.0			2.6
<18.5	17	6	35.3			-0.8
肿瘤距包膜（mm）
≤1	87	52	59.8	14.698	<0.001^b)
>1	116	38	32.8
肿瘤位置
上极	41	12	29.3	5.591	0.348
中极	56	26	46.4
下极	35	17	48.6
中上极	12	7	58.3
中下极	21	9	42.9
弥散	38	19	50.0

影响因素		OR	95%CI	P值
性别	男	2.797	1.246~6.275	0.013^a)
年龄（岁）	<45	3.726	1.639~8.473	0.002^a)
钙化	有	2.119	0.950~4.725	0.067
肿瘤直径（cm）	0.1~0.4			0.001^a)
	0.5~0.9	3.264	1.374~7.751	0.007^a)
	≥1.0	7.358	2.617~20.689	<0.001^a)
病灶数	多发	2.375	1.119~5.040	0.024^a)
肿瘤距包膜（mm）	≤1	3.399	1.689~6.840	0.001^a)
体质量指数（kg/m²）	18.5~23.9			0.181
	>23.9	1.707	0.791~3.686	0.173
	<18.5	0.544	0.164~1.810	0.321