乳头状甲状腺癌ER、PR表达与颈部淋巴结转移的相关性研究被引量：1

The correlation research between the expressions of ER、PR and cervical lymph node metastasis in patients with PTC

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摘要目的探讨乳头状甲状腺癌(Papillary Thyroid Carcinoma，PTC)ER、PR表达与颈部淋巴结转移之间的关系及在临床治疗中的价值。方法采用德国LEICABOND-MAX型全自动免疫组化CompactPolymer检测系统检测PTC原发灶中的ER、PR的表达，对67例PTC患者术后经大剂量131I治疗的临床资料进行回顾性分析。记录67例PTC患者术中所见肿瘤与周围组织粘连和侵犯的情况和颈部转移淋巴结在Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ、Ⅵ、Ⅶ区及锁骨上区的分布。研究患者性别、年龄、病灶大小、病灶个数、局部侵犯、ER和PR表达与颈部淋巴结转移的关系。两组间ER、PR受体表达及不同区域的淋巴结转移率的比较及影响ER、PR表达及颈部淋巴结转移单因素分析差异比较采用卡方检验，Logistic模型进行多因素分析。结果ER、PR阳性表达率分别为10.4%(7/67)和41.8%(28/67)，性别、年龄、淋巴结转移、局部侵犯比较无明显统计学意义(P>0.05)。单区域颈部淋巴结转移25.37%(17/67)，多区域转移43.28%(29/67)。转移淋巴结分布以IV区44.78%(30/67)和VI区34.33%(23/67)最常见，其余各区依次为V区25.37%(17/67)、III区20.90%(14/67)、II区17.91%(12/67)、锁骨上区11.94%(8/67)、VII区7.46%(5/67)、I区2.98%(2/67)。病灶大小，病灶个数是影响颈部淋巴结转移的危险因素。结论PTC患者颈部淋巴结转移以IV区、VI区最常见，其次为锁骨上区、V区和II区，肿瘤组织中ER、PR表达与否与颈部淋巴结转移无关，不能作为预测PTC颈部淋巴结转移及判断预后的标志。 Objective:To investigate the correlation between the expressions of estrogen receptors(ER),progesterone receptors(PR)and the patterns of cervical lymph node metastasis and the value of clinical therapy in patients with Papillary Thyroid Carcinoma(PTC).Method:The expression of ER and PR in primary tumors of67postoperative patients with PTC is tested by the system of full-automatic immunohistochemical Compact Polymer of LEICA BOND-MAX from Germany.67PTC patients after surgery ablated with high doses of131I from2010to2013were retrospectively reviewed.According to operative and pathological results recorded the adhesion and invasion of the tumor and the surrounding tissue and the distribution of metastatic cervical lymph nodes in level I,II,III,IV,V,VI VII and supraclavicular.The relationship between neck lymph node metastasis and clinical factors such as gender,age,focal size,number of lesions,local invasion,the expression of ER and PR and the relevant risk factors for ER and PR and lymph node metastasis were analyzed with univariate and multivariate analysis.Results:The positive rates of ER and PR in67PTC patients were10.4%(7/67)and41.8%(28/67).ER and PR positive expression compared with cervical lymph node metastasis,there was no statistically significant difference(P>0.05).The incidence of Single region metastasis of neck lymph node is25.37%(17/67)and multitude regions are43.28%(29/67).Lymph node metastasis is the most common in level IV44.78%(30/67)and level VI34.33%(23/67).The rest were level V25.37%(17/67),level III20.90%(14/67),level II17.91%(12/67),supraclavicular11.94%(8/67),level VII7.46%(5/67)and level I2.98%(2/67).The focal size(P=0.004)and number of lesions(P=0.049)are risk factors for cervical lymph node metastasis.Conclusion:Cervical lymph node metastasis is the most common in level IV and VI of patients with PTC,followed by the supraclavicular,level V and level II.The expression of ER,PR in tumor tissue has nothing to do with cervical lymph node metastasis.It cannot be used to predict cervical lymph