Risk Factors for central lymph node metastasis in 1 988 papillary thyroid microcarcinoma patients
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摘要: 目的:探讨1988例甲状腺微小乳头状癌(PTMC)颈部中央区淋巴结转移的危险因素。方法:回顾性分析新疆医科大学附属肿瘤医院2010-01-2016-03期间初治的PTMC癌患者的临床病理特征,通过χ2检验、多因素统计分析,探讨颈部中央区淋巴结转移的危险因素。结果:颈部中央区淋巴结转移率为34.9%。单因素分析显示,确诊年龄<45岁、男性、多灶、肿瘤位于双侧腺叶(含峡部)、肿瘤直径>5mm、包膜浸润、包膜外侵犯是颈部中央区淋巴结转移的危险因素(P<0.05);多因素分析显示,男性、确诊年龄<45岁、肿瘤直径>5mm、包膜浸润、包膜外侵犯是影响颈部中央区淋巴结转移的独立危险因素。肿瘤位置是单灶颈部中央区淋巴结转移的独立危险因素,其中单灶位于腺叶下极者中央区淋巴结转移率最高(46.8%);而多灶肿瘤位置与中央区淋巴结转移无关(P>0.05)。结论:当PTMC患者存在以下情况:男性、确诊年龄<45岁、肿瘤直径>5mm、包膜浸润、包膜外侵犯,单灶位于腺叶下极时,应警惕淋巴结转移可能,建议行积极诊治方案以及更加密切的术后随访。
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关键词:
- 甲状腺微小乳头状癌 /
- 颈部中央区淋巴结转移 /
- 危险因素
Abstract: Objective:To determine the risk factors that increase the neck central lymph node metastasis in papillary thyroid microcarcinoma(PTMC).Method:In this retrospective study,clinical and pathologic data were collected from patients who were first diagnosed as PTMC at the Xinjiang Medical University affiliated Tumor Hospital from January 2010 to March 2016. Chi-square test and multivariate logistic regression analysis were used to identify the risk factors of the neck central lymph node metastasis.Result:Of all 1988 patients,34.9% had the neck central lymph node metastasis. Age <45 years(P<0.05),male(P<0.05,),multifocality(P<0.05),bilaterality(P<0.05),tumor size >5 mm(P<0.05), capsular invasion(P<0.05)or extrathyroidal extension(P<0.05)were significantly correlated with the neck central lymph node metastasis. Multivariate logistic regression analysis indicated that male, age <45 years, tumor size >5 mm,capsular invasion,extrathyroidal extension were independently correlated with the neck central lymph node metastasis. For patients with a solitary primary tumor, tumor location was independently correlated with the neck central lymph node metastasis.Unifocal tumor location in the lower third of the thyroid lobe was associated with the highest risk of the neck central lymph node metastasis(46.8%)(P<0.05). Multifocal tumor location was not associated with the neck central lymph node metastasis(P>0.05).Conclusion:More aggressive treatment or more frequent follow-up could be considered for patients with unfavorable features(male gender, age <45 years,tumor size >5 mm,capsular invasion,extrathyroidal extension,unifocal tumor location in the lower third of the thyroid lobe), as these patients may be at an increased risk for the neck central lymph node metastasis. -
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[1] STEWART B W,WILD C.World cancer report 2014[M].WHO:Switzerland,2014:630-630.
[2] HAUGEN B R,ALEXANDER E K,BIBLE K C,et al.2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer:The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer[J].Thyroid,2016,26:1-133.
[3] HEDINGER C,WILLIAMS E D,SOBIN L H.The WHO histological classification of thyroid tumors:a commentary on the second edition[J].Cancer,1989,63:908-911.
[4] QU N,ZHANG L,JI Q H,et al.Risk ractors for central compartment lymph node metastasis in papillary thyroid microcarcinoma:a Meta-Analysis[J].World J Surg,2015,39:2459-2470.
[5] YEH M W,BAUER A J,BERNET V A,et al.American Thyroid Association statement on preoperative imaging for thyroid cancer surgery[J].Thyroid,2015,25:3-14.
[6] CHO S Y,LEE T H,KU Y H,et al.Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number,the size of metastatic foci,and the presence of desmoplasia[J].Surgery,2015,157:111-118.
[7] PEREIRA J A,JIMENO J,MIQUEL J,et al.Nodal yield,morbidity,and recurrence after central neck dissection for papillary thyroid carcinoma[J].Surgery,2005,138:1095-1101.
[8] KIM S K,PARK I,WOO J W,et al.Predictive Factors for Lymph Node Metastasis in Papillary Thyroid Microcarcinoma[J].Ann Surg Oncol,2016,23:2866-2873.
[9] YAN H,ZHOU X,JIN H,et al.A study on central lymph node Metastasis in 543cN0papillary thyroid carcinoma patients[J].Int J Endocrinol,2016,2016:187-194.
[10] LU Z Z,ZHANG Y,WEI S F,et al.Outcome of papillary thyroid microcarcinoma:Study of 1,990cases[J].Mol Clin Oncol,2015,3:672-676.
[11] XIANG D,XIE L,XU Y,et al.Papillary thyroid microcarcinomas located at the middle part of the middle third of the thyroid gland correlates with the presence of neck metastasis[J].Surgery,2015,157:526-533.
[12] CAI Y F,WANG Q X,NI C J,et al.A scoring system is an effective tool for predicting central lymph node metastasis in papillary thyroid microcarcinoma:a case-control study[J].World J Surg Oncol,2016,14:45-49.
[13] SIDDIQUI S,WHITE M G,ANTIC T,et al.Clinical and pathologic predictors of lymph node Metastasis and recurrence in papillary thyroid microcarcinoma[J].Thyroid,2016,26:807-815.
[14] WADA N,DUH Q Y,SUGINO K,et al.Lymph node metastasis from 259papillary thyroid microcarcinomas:frequency,pattern of occurrence and recurrence,and optimal strategy for neck dissection[J].Ann Surg,2003,237:399-407.
[15] WANG T S,GOFFREDO P,SOSA J A,et al.Papillary thyroid microcarcinoma:an over-treated malignancy[J]?World J Surg,2014,38:2297-2303.
[16] GUO Y,LIU Z,YU P,et al.Using foci number to predict central lymph node metastases of papillary thyroid microcarcinomas with multifocality[J].Int J Clin Exp Med,2015,8:9925-9930.
[17] ZHANG L,WEI W J,JI Q H,et al.Risk factors for neck nodal metastasis in papillary thyroid microcarcinoma:a study of 1066patients[J].J Clin Endocrinol Metab,2012,97:1250-1257.
[18] SO Y K,KIM M W,SON Y I.Multifocality and bilaterality of papillary thyroid microcarcinoma[J].Clin Exp Otorhinolaryngol,2015,8:174-178.
[19] 彭琛,魏松锋,郑向前,等.1401例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析[J].中国肿瘤临床,2016,24(2):95-99.
[20] XU D,LV X,WANG S,et al.Risk factors for predicting central lymph node metastasis in papillary thyroid microcarcinoma[J].Int J Clin Exp Pathol,2014,7:6199-6205.
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