甲状腺乳头状癌Delphian淋巴结转移的危险因素

doi:10.16139/j.1007-9610.2022.05.014

摘要/Abstract

摘要： 目的研究甲状腺乳头状癌Delphian淋巴结转移的危险因素。方法回顾性分析2017年7月至2019年7月在台州市肿瘤医院首次就诊并经手术病理确诊为甲状腺乳头状癌的99例病人资料，分析Delphian淋巴结的转移与原发肿瘤的直径、位置、中央区淋巴结转移的相关性。结果在甲状腺乳头状癌根治术的病人中，Delphian淋巴结的检出率为70.7%（70/99），转移率为18.6%（13/70），转移病人为13.1%（13/99）。单因素分析显示，Delphian淋巴结转移与检出淋巴结数（t=7.040, P=0.008）、年龄（t=4.714, P=0.030）、肿瘤位于峡部（t=11.588, P=0.001）、气管前淋巴结转移（t=8.659, P=0.003）相关；与性别、肿瘤直径、多灶癌、双侧癌、包膜外侵犯、肿瘤位于甲状腺上极不相关（P>0.05）。多因素Logistics回归分析显示，峡部癌（P=0.010, OR=9.079）、淋巴结检出>2枚（P=0.005, OR=18.739）、气管前淋巴结转移（P=0.013, OR=8.530）是Delphian淋巴结转移的独立危险因素。结论对于甲状腺峡部癌、气管前淋巴结转移、喉前淋巴组织丰富的甲状腺乳头状癌病人，行中央区淋巴结清扫时应重视对Delphian淋巴结的清扫。

关键词: 甲状腺乳头状癌, Delphian淋巴结, 中央区淋巴结清扫

Abstract: Objective To investigate the risk factors for Delphian lymph node metastasis in papillary thyroid carcinoma. Methods Retrospective analysis of 99 patients treated in Taizhou Cancer Hospital from July 2017 to July 2019 were done in this study. Delphian lymph nodes metastasis related with tumor diameter, location or central lymph node metastasis were analyzed. Results The rate of detected Delphian lymph node in the patients with radical operation of papillary thyroid carcinoma was 70.7% (70/99) with the metastasis rate 18.6% (13/70). Totally 13 in 99 cases (13.1%) were found metastasis. Univariate analysis showed that Delphian lymph node metastasis was related with the number of lymph nodes detected (t=7.040, P=0.008), age (t=4.714, P=0.030), the foci located at isthmus (t=11.588, P=0.001), and pretracheal lymph node metastasis (t=8.659, P=0.003). There was no significant relationship between Delphian lymph node metastasis and gender, tumor diameter, multiple foci, bilateral lesions, extrathyroid invasion, or foci located in upper third of thyroid lobe (P>0.05). Multivariate Logistics analysis showed that isthmus carcinoma (P=0.010, OR=9.079), more than 2 Delphian lymph nodes (P=0.005, OR=18.739), and pretracheal lymph node metastasis (P=0.013, OR=8.530) were independent risk factors of Delphian lymph node metastasis. Conclusions It should be paid more attention to Delphian lymph node during central department lymph node dissection for those patients with thyroid isthmus carcinoma, pretracheal lymph node metastasis and many lymph nodes.

Key words: Papillary thyroid carcinoma, Delphian lymph node, Central lymph node dissection

中图分类号:

R736.1

颜海波, 夏中平, 陈善, 姜琳, 韩春. 甲状腺乳头状癌Delphian淋巴结转移的危险因素[J]. 外科理论与实践, 2022, 27(05): 453-457.

YAN Haibo, XIA Zhongping, CHEN Shan, JIANG Lin, HAN Chun. Risk factors for Delphian lymph node metastasis in papillary thyroid carcinoma[J]. Journal of Surgery Concepts & Practice, 2022, 27(05): 453-457.

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项目	DLN结转移		t值	P值
项目	有（n=13）	无（n=86）	t值	P值
年龄（岁） ≥55 <55	1（2.9%） 12（18.5%）	33（97.1%） 53（81.5%）	4.714	0.030
性别女男	9（11.8%） 4（17.4%）	67（88.2%） 19（82.6%）	0.477	0.490
肿瘤直径（cm） ≤1.0 >1.0	6（8.8%） 7（22.6%）	62（91.2%） 24（77.4%）	3.533	0.060
多灶癌是否	6（19.4%） 7（10.3%）	25（80.6%） 61（89.7%）	1.532	0.216
双侧癌是否	2（11.1%） 11（13.6%）	16（88.9%） 70（86.4%）	0.079	0.779
癌灶位于峡部是否	7（36.8%） 6（7.5%）	12（63.2%） 74（92.5%）	11.588	0.001
包膜外侵犯是否	2（22.2%） 11（12.2%）	7（77.8%） 79（88.8%）	0.719	0.397
癌灶位于上极中、下部	3（9.7%） 10（14.7%）	28（90.3%） 58（85.3%）	0.472	0.492
DLN检出数（枚） ≤2 >2	9（10.1%） 4（40.0%）	80（89.9%） 6（60.0%）	7.040	0.008
气管前淋巴结转移是否	7（31.8%） 6（7.8%）	15（68.2%） 71（92.2%）	8.659	0.003

项目	P值	OR	95% CI
年龄<55岁	0.072	0.113	0.011~1.211
癌灶位于峡部	0.010	9.079	1.702~48.429
DLN检出>2（枚）	0.005	18.739	2.382~147.402
气管前淋巴结转移	0.013	8.530	1.559~46.672