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目的分析临床颈淋巴结阴性(cN0)单侧甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患侧及对侧中央区淋巴结转移(central lymph node metastasis,CLNM)的规律及危险因素。方法回顾性分析2014年6月至2015年8月我科收治的46例cN0单侧PTC患者的临床病理资料,包括性别、年龄、癌灶数量、肿瘤直径、腺外浸润情况、是否合并桥本甲状腺炎(Hashimoto thyroiditis,HT)、T分期等,总结cN0单侧PTC患者患侧及对侧CLNM的规律,并应用χ2检验和多元logistic回归模型分析其危险因素。结果患侧及对侧CLNM发生率分别为32.6%(15/46)和21.7%(10/46),在对侧转移的患者中,仅对侧发生CLNM者占70.0%(7/10)。其中T1、T2期患者共发生CLNM 20例(48.8%,20/41)。单因素分析表明,年龄<45岁、肿瘤直径>1cm、不合并HT与患侧CLNM有关(P<0.05),所有临床病理因素均与对侧CLNM无关(P>0.05)。多因素分析表明,肿瘤直径>1cm(OR=4.890,P=0.044)是患侧CLNM的独立危险因素,而合并HT(OR=0.086,P=0.034)是患侧CLNM的保护因素;多灶癌(OR=7.60,P=0.038)是对侧CLNM的独立危险因素。在仅发生患侧CLNM和仅发生对侧CLNM的患者中,合并HT时更易发生对侧CLNM(P<0.05)。结论在cN0单侧PTC患者中,患侧CLNM最为常见,也可仅发生对侧CLNM;T1、T2期患者CLNM率较高,建议行预防性中央区淋巴结清扫(prophylactic central lymph node dissection,PCND);肿瘤直径>1cm时,建议行患侧PCND;肿瘤为多灶癌、合并HT时,行对侧PCND价值更大。
Objective To analyze the regularity and risk factors of central lymph node metastasis (CLNM) in the unilateral papillary thyroid carcinoma (PTC) with clinical cervical lymph node negative (cN0). Methods The clinical and pathological data of 46 patients with cN0 unilateral PTC treated in our department from June 2014 to August 2015 were retrospectively analyzed, including gender, age, number of foci, diameter of tumor, infiltration of extra-gland, whether Hashimoto Hashimoto thyroiditis (HT), T stage and so on. The regularity of ipsilateral and contralateral CLNM in patients with cN0 unilateral PTC was summarized. The risk factors of CLNM were analyzed byχ2 test and multivariate logistic regression model. Results The incidences of ipsilateral and contralateral CLNM were 32.6% (15/46) and 21.7% (10/46), respectively. Only 70.0% (7/10) of the patients with contralateral metastasis had CLNM. Among T1 and T2 patients, there were 20 CLNM cases (48.8%, 20/41). Univariate analysis showed that age <45 years and tumor diameter> 1cm. There was no correlation between HT and CLNM in affected side (P <0.05). All clinicopathological factors were independent of contralateral CLNM (P> 0.05). Multivariate analysis showed that tumor diameter> 1cm (OR = 4.890, P = 0.044) was an independent risk factor for ipsilateral CLNM, and combined HT (OR = 0.086, P = 0.034) was a protective factor for ipsilateral CLNM. (OR = 7.60, P = 0.038) was an independent risk factor for contralateral CLNM. In patients with ipsilateral CLNM and contralateral CLNM only, contralateral CLNM was more likely to occur with HT (P <0.05). Conclusions In patients with cN0 unilateral PTC, the ipsilateral CLNM is the most common and contralateral CLNM may occur only. Patients with T1 and T2 stages have a higher CLNM rate. Prophylactic central lymph node dissection (PCND) ; When the diameter of the tumor is> 1cm, PCND of the affected side is recommended; the tumor is multifocal; when the HT is combined, the value of PCND in the contralateral side is greater.