摘要
背景与目的:甲状腺微小乳头癌(PTMC)发病率逐年增高,侧颈淋巴结转移(LLNM)时将影响患者生存率。本文旨在探讨PTMC发生LLNM的相关危险因素与预测指标,为临床诊疗依据提供参考。方法:回顾性分析大连市友谊医院2015年1月—2020年6月收治的PTMC患者的临床资料。观察临床资料除了LLNM的发生情况,还包括性别、年龄、肿瘤数目、肿瘤大小、肿瘤位置、病变腺叶、体质量指数、是否侵犯甲状腺被膜、是否合并甲状腺其他疾病(桥本甲状腺炎、结节性甲状腺肿),以及是否伴有中央区淋巴结转移(CLNM)。结果:共纳入342例PTMC患者,其中发生LLNM的33例(9.6%),发生CLNM的142例(41.5%),发生CLNM并LLNM者25例(7.3%);33例LLNM患者中,8例(24.2%)无CLNM。单因素分析结果显示,男性、肿瘤直径≥5 mm、甲状腺被膜侵犯、CLNM的患者更容易发生LLNM(均P<0.05)。多因素分析结果显示,CLNM转移数目是LLNM的独立危险因素(OR=1.195,P<0.05)。ROC曲线分析结果显示,CLNM数目预测LLNM的AUC为0.621,临界值为4.5枚,特异度为0.897和敏感度为0.103。结论:CLNM数目与PTMC患者发生LLNM密切相关,CLNM数目可为治疗性侧颈淋巴结清扫提供一定的量化参考。
Background and Aims:The incidence of papillary thyroid microcarcinoma(PTMC)has been increasing over the past years,and the presence of lateral lymph node metastasis(LLNM)will affect the survival rates of patients.The purpose of this study was to investigate the risk factors and predictive variables for the occurrence of LLNM in PTMC,so as to provide reference for clinical diagnosis and treatment.Methods:The clinical data of PTMC patients treated in Dalian Friendship Hospital from January 2015 to June 2020 were retrospectively analyzed.Except for the occurrence of LLNM,the clinical variables observed included sex,age,and the number,size,and location of tumor,as well as the affected glandular lobes,body mass index,and the presence or absence of thyroid capsule invasion,other concomitant thyroid diseases(Hashimoto's thyroiditis,nodular goiter),and combined central lymph node metastasis(CLNM).Results:A total of 342 PTMC patients were enrolled,of whom,LLNM occurred in 33 cases(9.6%),CLNM occurred in 142 cases(41.5%),and 25 cases(7.3%)had both CLNM and LLNM.Of the 33 patients with LLNM,8 cases(24.2%)had no CLNM.Univariate analysis showed that patients with male sex,tumor diameter≥5 mm,capsule invasion and CLNM were more likely to develop LLNM(all P<0.05).Multivariate analysis showed that the number of CLNM was an independent risk factor for LLNM(OR=1.195,P<0.05).ROC analysis showed that the AUC of CLNM number for estimating LLNM was 0.621,and the cut-off value was 4.5,with a specificity of 0.897 and sensitivity of 0.103.Conclusion:The number of CLNM is closely related to the LLNM in PTMC patients,which can provide certain quantitative reference for therapeutic lateral lymph node dissection.
作者
孔令欣
王照华
殷文斌
李会政
KONG Lingxin;WANG Zhaohua;YIN Wenbin;LI Huizheng(Jinzhou Medical University Dalian Friendship Hospital Postgraduate Training Base,Dalian,Liaoning 116001,China;Department of Otolaryngology-Head and Neck Surgery,Dalian Friendship Hospital,Dalian,Liaoning 116001,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2021年第5期537-542,共6页
China Journal of General Surgery
