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目的:探讨cN_0期甲状腺乳头状微小癌(PTMC)的临床特点及中央区淋巴结隐性转移的危险因素。方法:回顾性分析372例行甲状腺切除术及预防性中央区淋巴结清扫cN_0期甲状腺乳头状癌(PTC)患者临床资料,将其中250例PTMC患者(肿瘤直径≤1.0 cm)作为研究组,122例普通PTC患者(肿瘤直径>1.0-2.0 cm)作为对照组,通过比较两组患者临床病理及影像学资料,分析PTMC的临床特点及中央区淋巴结隐性转移的危险因素。结果:研究组与对照组中央区颈部淋巴结转移率分别为32.8%(82/250)和42.6%(52/122),差异无统计学意义(P>0.05)。单因素分析显示,研究组中央淋巴结转移与肿瘤大小、多灶性肿瘤、包膜侵润有关(均P<0.05),而与结节的超声特征及其他因素无关(均P>0.05);对照组中央淋巴结转移与各研究因素均无明显关系(均P>0.05)。多因素分析发现,肿瘤大小(OR=2.916,95%CI=1.19-4.37)、多灶性肿瘤(OR=1.230,95%CI=0.68-2.75)、包膜侵润(OR=1.923,95%CI=1.06-3.70)是PTMC中央区淋巴结转移的危险因素(均P<0.05)。结论:cN_0期PTMC中央区淋巴结转移率与普通PTC相似,肿瘤大小、多灶性肿瘤、包膜侵润是cN_0期PTMC淋巴结转移的危险因素。
Objective: To investigate the clinical features of cN_0 papillary thyroid carcinoma (PTMC) and the risk factors of implicit metastasis in central lymph nodes. Methods: A retrospective analysis of 372 cases of thyroidectomy and prophylactic central lymph node dissection cN_0 thyroid papillary carcinoma (PTC) clinical data, of which 250 cases of PTMC patients (tumor diameter ≤ 1.0 cm) as the study group, 122 cases The common PTC patients (tumor diameter> 1.0-2.0 cm) served as the control group. The clinical features and the risk factors of latent lymph node metastasis in the central area were analyzed by comparing the clinicopathological and imaging data of the two groups. Results: The cervical lymph node metastasis rate was 32.8% (82/250) and 42.6% (52/122) in study group and control group, respectively, with no significant difference (P> 0.05). Univariate analysis showed that the central lymph node metastasis in the study group was related to tumor size, multifocal tumor and invasion (all P <0.05), but not to the sonographic features of nodules and other factors (all P> 0.05) Central lymph node metastasis and no significant relationship between the various factors (all P> 0.05). Multivariate analysis showed that tumor size (OR = 2.916, 95% CI = 1.19-4.37), multifocal tumor (OR = 1.230, 95% CI = 0.68-2.75) CI = 1.06-3.70) were the risk factors of lymph node metastasis in the central region of PTMC (all P <0.05). CONCLUSION: Central lymph node metastasis rate in cN_0 stage is similar to that in normal PTC. Tumor size, multifocal tumor and invasion of ciliated tumor are the risk factors of cN_0 stage PTMC lymph node metastasis.