摘要
目的:由于仍缺乏对甲状腺乳头状癌(PTC)中央区淋巴结转移(CLNM)准确的术前诊断方法,故目前对于是否应行预防性中央区淋巴结清扫术(CLND)仍有争议.本研究旨在探讨甲状腺乳头状癌颈部CLNM的相关危险因素,为进行CLND提供理论依据.方法:选取行颈部CLND并最终病理确诊为PTC的患者140例,将患者的各项临床病理相关因素作为自变量,以CLNM作为因变量,应用卡方检验及二分类变量Logistic回归模型进行分析,以期分析甲状腺乳头状癌CLNM的高危因素.结果:恶性肿瘤数目(P=0. 277)、伴结节性甲状腺肿(P=0. 811)、伴甲状腺良性肿瘤(P=0. 152)、伴桥本氏病(P=0. 399)、术前彩超显示低回声(P=0. 174)与中央区淋巴结转移无相关性,年龄(P=0. 037)、性别(P=0. 008)、肿瘤大小(P=0. 004)及彩超提示微钙化(P=0. 006)与CLNM有关,且年龄(P=0. 016,OR=0. 383)、性别(P=0. 016,OR=3. 167)、肿瘤大小(P=0. 003,OR=3. 244)以及彩超提示微钙化(P=0. 006,OR=3. 148)是其独立危险因素.结论:在甲状腺乳头状癌发生CLNM的患者中,彩超提示微钙化、肿瘤大小、年龄以及性别均作为独立危险因素,临床决策是否行预防性CLND时应充分评估上述多个独立危险因素,并综合考虑作出合理的个性化诊疗方案.
Objective: Due to the lack of accurate preoperative diagnosis methods for central lymph node metastasis (CLNM) of papillary thyroid carcinoma (PTC), it is still controversial whether preventive central lymph node dissection (CLND) should be performed. The purpose of this study is to investigate the clinical risk factors of CLNM in PTC, thus to provide theoretical evidence for central lymph node dissection. Methods: One hundred and forty patients who were performed with CLND and finally confirmed with PTC by pathology in the Second Affiliated Hospital of Chongqing Medical University were collected. Taking the clinical pathologic factors as independent variables and CLNM as the dependent variable, chi-square test and the binary Logistic regression model was used to analyze and figure out the high-risk factors of CLNM in patients with PTC. Results: Number of malignant nodules (P=0.277), with nodular goiter (P=0.811), with thyroid benign tumors (P=0.152), with Hashimoto's disease (P=0.399), ultrasound indicating hypoechoic (P=0.174) were of no correlation with central lymph node metastasis, but age (P=0.037), gender (P=0.008), tumor size (P=0.004) and ultrasound indicating microcalcification (P=0.006) were associated with central lymph node metastasis. Age (P=0.016, OR=0.383), gender (P=0.016, OR=3.167), tumor size (P=0.003, OR=3.244), and microcalcification (P=0.006, OR=3.148) were independent risk factors as well. Conclusion: In patients of PTC with CLNM, microcalcification, tumor size, age and gender were the independent predictive risk factors. All these independent risk factors should be fully evaluated to make clinical decision of prophylactic CLND, and a reasonable personalized diagnosis and treatment plan should be made by comprehensive consideration.
作者
李顺波
黄晶晶
郭丹
LI Shunbo;HUANG Jingjing;GUO Dan(Department of Surgery, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, China)
出处
《暨南大学学报（自然科学与医学版）》
CAS
CSCD
北大核心
2018年第6期524-528,共5页
Journal of Jinan University(Natural Science & Medicine Edition)
基金
重庆市科学技术委员会基金项目(cstc2013jcyjA10097)
