Risk factors of skip lateral cervical lymph node metastasis in papillary thyroid carcinoma
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摘要: 目的 探讨甲状腺乳头状癌(PTC)患者出现跳跃性颈侧区淋巴结转移的发生率及其危险因素。方法 回顾性分析2018年1月—2022年1月在河北北方学院附属第一医院耳鼻咽喉头颈外科接受甲状腺腺叶全切除+中央区+颈侧区淋巴结清扫手术的85例PTC患者的临床及病理资料，术后病理学检查证实颈侧区淋巴结转移。采用SPSS 26.0软件处理数据，并对出现跳跃性颈侧区淋巴结转移者进行单因素和多因素分析。结果 发生跳跃性颈侧区淋巴结转移者31例(36.5%)。单因素分析结果显示，肿瘤最大直径≤5 mm(P=0.006)、肿瘤位于甲状腺上极(P=0.002)与PTC患者发生跳跃性颈侧区淋巴结转移有关; 跳跃性转移多累及单个区域(18/31，58.1%)，其中Ⅲ区最易受累(10/31，32.3%)，其次为Ⅱ区(5/31，16.1%); 二元logistic分析结果显示，肿瘤直径≤5 mm(OR 7.800，95%CI 1.710~21.394，P=0.005)以及肿瘤位于腺体上极(OR 4.060，95%CI 1.468~11.235，P=0.007)是PTC患者发生跳跃性颈侧区淋巴结转移的独立危险因素。结论 肿瘤直径≤5 mm、肿瘤位于腺体上极的PTC患者更易发生跳跃性颈侧区淋巴结转移。当肿瘤直径≤5 mm、肿瘤位于腺体上极时，术前应仔细评估，即使在没有中央区淋巴结转移的情况下，也应该注意颈侧区淋巴结转移的可能性。Abstract: Objective To investigate the incidence and risk factors of skip lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma(PTC).Methods The clinical and pathological data of 85 patients with PTC who underwent total thyroidectomy plus central and lateral neck dissection in the Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Hebei North University from January 2018 to January 2022 were analyzed retrospectively. SPSS 26.0 software was used to process the data, and univariate and multivariate analysis were performed to assess the relationships between skip lateral cervical lymph node metastasis and clinicopathological characteristics.Results There were 31 cases(36.5%) of skipped lateral cervical lymph node metastasis. Univariate analysis showed that the largest tumor diameter ≤5 mm(P=0.006) and the tumor located in the upper pole of the thyroid(P=0.002) were associated with the occurrence of skip lateral cervical lymph node metastasis in patients with PTC. Most of the skip metastases involved a single area(18/31, 58.1%), of which area Ⅲ was most likely to be involved(10/31, 32.3%), followed by area Ⅱ(5/31, 16.1%). The results of binary logistic analysis showed that tumor diameter less than 5 mm(OR 7.800, 95%CI 1.710-21.394, P=0.005) and tumor at the upper pole of the gland(OR 4.060, 95%CI 1.468-11.235, P=0.007) were independent risk factors of skip lateral cervical lymph node metastasis in PTC patients.Conclusion PTC patients with tumor diameter ≤5 mm and tumor located in the upper pole of the gland are more prone to skip lateral cervical lymph node metastasis. When the diameter of the tumor is less than 5 mm and the tumor is located at the upper pole of the gland, careful evaluation should be made before operation, even in the absence of central lymph node metastasis, attention should be paid to the possibility of lateral cervical lymph node metastasis.
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Key words:
- papillary thyroid carcinoma /
- lymph node metastasis /
- risk factors
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表 1 PTC患者跳跃性颈侧区淋巴转移的临床病理特征
临床特征 跳跃性转移 χ2/t/Z值 P值 阳性(n=31) 阴性(n=54) 性别/例 男 4 11 0.756 0.385 女 27 43 年龄/岁 47.84±9.536 46.11±12.941 0.648 0.519 < 45 10 23 0.886 0.347 ≥45 21 31 肿瘤大小/mm 8.00(5.00，12.00) 14.00(9.00，17.00) 2.717 0.007 ≤5 11 6 10.283 0.006 6~10 9 11 >10 11 37 肿瘤位置/例 累计上极 17 12 9.321 0.002 未累及上极 14 42 浸润性生长/例 是 13 18 0.629 0.428 否 18 36 多灶性/例 是 8 34 0.711 0.399 否 23 20 单双侧/例 单侧 18 38 1.327 0.249 双侧 13 16 合并桥本甲状腺炎/例 是 9 14 0.096 0.756 否 22 40 合并结节性甲状腺肿/例 是 8 21 1.500 0.221 否 23 33 术前TG/(ng·mL-1) 17.33(0.65，84.20) 12.44(1.95，58.40) 0.065 0.948 淋巴结转移数量/枚 中央区转移 — 3.33±2.862 6.469 < 0.001 中央区检出 1.58±2.110 5.63±4.515 4.698 < 0.001 颈侧区转移 2.71±1.657 4.13±4.778 1.597 0.114 颈侧区检出 10.42±8.461 9.30±9.538 0.554 0.588 
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表 2 PTC患者跳跃性颈侧区淋巴转移危险因素logistic分析
因素 OR 95%CI P值 肿瘤直径/mm ≤5 7.800 1.710~21.394 0.005 6~10 1.983 0.719~7.488 0.159 >10 — — — 肿瘤位置 累及上极 4.060 1.468~11.235 0.007 未累及上极 — — —
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表 3 跳跃性颈侧区淋巴结转移的区域分布
累及区域 例数(%) 累及单个区域颈侧区淋巴结水平 Ⅱ区 5(16.1) Ⅲ区 10(32.3) Ⅳ区 3(9.7) 累及两个区域颈侧区淋巴结水平 Ⅱ+Ⅲ区 6(19.4) Ⅲ+Ⅳ区 3(9.7) 累及三个区域颈侧区淋巴结水平 Ⅱ+Ⅲ+Ⅳ区 4(12.9)
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