Analysis of Delphain lymph node detection rate, metastasis rate and risk factors for metastasis in papillary thyroid adenocarcinoma patients
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摘要: 目的 探讨甲状腺乳头状癌(papillary thyroid carcinoma，PTC)德尔法淋巴结(delphain lymph node，DLN)检出率与转移率，并分析影响DLN转移的危险因素。 方法 回顾性分析2018年1月—2020年6月收治的200例PTC患者的临床病理资料，所有对象的病理报告中均明确记录DLN检测情况。统计DLN检出数目、转移数目以及检出率和转移率，对可能影响DLN转移的临床病理因素进行单因素分析以及多因素logistic回归分析，包括性别、年龄、肿瘤大小、肿瘤位置等。 结果 200例PTC患者中有121例检出DLN，检出率为60.50%(121/200)。检出的121例患者中，出现DLN转移46例，转移率为38.02%(46/121)。单因素分析显示，肿瘤直径、多发灶、包膜侵犯、腺外侵犯、淋巴脉管浸润、中央区淋巴结(不包括DLN)转移、侧颈淋巴结转移是PTC发生DLN转移的危险因素(P＜0.05); 性别、年龄、肿瘤位置、双侧肿瘤、桥本甲状腺炎、BRAFV600E突变与PTC发生DLN转移的关系差异无统计学意义(P>0.05)。将单因素分析中7项差异有统计学意义的变量纳入logistic回归模型进行多因素分析，结果显示，肿瘤直径≥1.0 cm、包膜侵犯、淋巴脉管浸润、中央区淋巴结(不包括DLN)转移、侧颈淋巴结转移是PTC发生DLN转移的独立危险因素(OR=3.386~9.186，P＜0.05)。PTC患者DLN转移预测中央区淋巴结(不包括DLN)转移的敏感度与特异度分别为36.79%、92.55%，而预测侧颈淋巴结转移的敏感度、特异度分别为41.03%、81.37%。DLN阳性患者发生中央区淋巴结(不包括DLN)转移是DLN阴性患者的4.94倍，DLN阳性患者发生侧颈淋巴结转移是DLN阴性患者的2.20倍。 结论 PTC患者DLN检出率与转移率较高，DLN转移预示着更广泛的淋巴结转移，且DLN转移与多种因素有关，其中肿瘤直径≥1.0 cm、包膜侵犯、淋巴脉管浸润、中央区淋巴结(不包括DLN)转移、侧颈淋巴结转移是PTC发生DLN转移的独立危险因素，因此具有上述特征的PTC患者应积极探查DLN，制定合适的手术策略。Abstract: Objective To investigate the detection rate and metastasis rate of delphain lymph node (DLN)in thyroid papillary adenocarcinoma(PTC) and to analyze the risk factors for DLN metastasis. Methods The clinicopathological data of 200 PTC patients admitted to the from January 2018 to June 2020 were retrospectively analyzed, and the detection of DLN was clearly recorded in the pathological reports of all patients. The number of DLN detected, the number of metastasis, the detection rate and the metastasis rate were counted. The clinicopathological factors that might affect DLN metastasis were analyzed by univariate analysis and multivariate Logistic regression analysis, including gender, age, tumor size and tumor location. Results DLN was detected in 121 of 200 PTC patients, with a detection rate of 60.50% (121/200). DLN metastasis was found in 46 of the 121 patients with a metastasis rate of 38.02% (46/121).Univariate analysis showed that tumor diameter, multiple foci, capsular invasion, extradandular invasion, lymphatic vascular invasion, lymph node metastasis in central region (excluding DLN), and lateral cervical lymph node metastasis were the risk factors for DLN metastasis of PTC (P < 0.05). Gender, age, tumor location, bilateral tumors, Hashimoto's thyroiditis and BRAFV600E mutation were not significantly correlated with DLN metastasis of PTC(P>0.05). The 7 variables with statistically significant differences in univariate analysis were incorporated into Logistic regression model for multivariate analysis, and the results showed that, Tumor diameter ≥1.0 cm, capsule invasion, lymphatic vascular invasion, lymph node metastasis in central region (excluding DLN), and lateral cervical lymph node metastasis were independent risk factors for DLN metastasis of PTC (OR= 3.386-9.186, P < 0.05). The sensitivity and specificity of DLN metastasis in predicting central lymph node (excluding DLN) metastasis in PTC patients were 36.79% and 92.55%, respectively, while the sensitivity and specificity of DLN metastasis in predicting lateral cervical lymph node metastasis were 41.03% and 81.37%, respectively.The incidence of central lymph node metastasis (excluding DLN) in DLN-positive patients were was 4.94 times higher than that in DLN-negative patients, and the incidence of lateral neck lymph node metastasis in DLN-positive patients were 2.20 times higher than that in DLN-negative patients. Conclusion The detection rate and metastasis rate of DLN in PTC patients were higher, DLN metastasis predicts more extensive lymph node metastasis, and DLN metastasis was related to multiple factors, among which tumor diameter ≥ 1.0 cm, capsule invasion, lymphatic vascular infiltration, lymph node metastasis in the central region (excluding DLN), and lateral cervical lymph node metastasis were independent risk factors for DLN metastasis of PTC. Therefore, PTC patients with the above characteristics should actively explore DLN and formulate appropriate surgical strategies.
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Key words:
- papillary thyroid carcinoma /
- delphain lymph node /
- lymph node metastasis /
- risk factors
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表 1 PTC患者DLN转移的单因素分析
例(%) 临床病理因素 例数 DLN阳性(n=46) DLN阴性(n=154) χ2 P 性别 0.222 0.637 男 47 12(26.09) 35(22.73) 女 153 34(73.91) 119(77.27) 年龄 1.485 0.223 ＜45岁 106 28(60.87) 78(50.65) ≥45岁 94 18(39.13) 76(49.35) 肿瘤直径 10.414 0.001 ＜1.0 cm 131 21(45.65) 110(71.43) ≥1.0 cm 69 25(54.35) 44(28.57) 肿瘤位置 2.131 0.144 峡部及上1/3 69 20(43.48) 49(31.82) 中部及下部 131 26(56.52) 105(68.18) 多发灶 4.874 0.027 是 89 27(58.70) 62(40.26) 否 111 19(41.30) 92(59.74) 双侧肿瘤 0.213 0.645 是 64 16(34.78) 48(31.17) 否 136 30(65.22) 106(68.83) 桥本甲状腺炎 0.125 0.723 有 61 15(32.61) 46(29.87) 无 139 31(67.39) 108(70.13) BRAFV600E 0.160 0.689 突变 57 19(76.00) 38(71.70) 野生 21 6(24.00) 15(28.30) 包膜侵犯 5.089 0.024 是 68 22(47.83) 46(29.87) 否 132 24(52.17) 108(70.13) 腺外侵犯 11.252 0.001 是 33 15(32.61) 18(11.69) 否 167 31(67.39) 136(88.31) 淋巴脉管浸润 21.431 ＜0.001 是 28 16(34.78) 12(7.79) 否 172 30(65.22) 142(92.21) 中央区淋巴结(不包括DLN)转移 24.226 ＜0.001 有 106 39(84.78) 67(43.51) 无 94 7(15.22) 87(56.49) 侧颈淋巴结转移 8.889 0.003 有 39 16(34.78) 23(14.94) 无 161 30(65.22) 131(85.06) 
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表 2 PTC患者DLN转移的多因素logistic回归分析
变量 β SE Wald χ2 OR 95%CI P 肿瘤直径≥1.0 cm 1.875 0.456 10.275 5.421 1.764~18.275 0.001 多发灶 1.234 0.375 3.324 1.876 1.034~7.234 0.186 包膜侵犯 1.275 0.357 8.654 3.386 1.358~15.037 0.016 腺外侵犯 1.464 0.412 4.084 2.141 1.175~10.472 0.065 淋巴脉管浸润 1.347 0.275 9.386 4.210 1.686~18.137 0.005 中央区淋巴结(不包括DLN)转移 1.423 0.412 14.234 9.186 2.265~24.356 ＜0.001 侧颈淋巴结转移 1.556 0.396 12.386 3.754 1.587~16.456 ＜0.001
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表 3 PTC患者DLN转移预测中央区淋巴结(不包括DLN)转移的准确性
例 病理标准 例数 DLN转移 阳性 阴性 阳性 106 39 67 阴性 94 7 87 合计 200 46 154
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表 5 PTC患者DLN转移预测中央区淋巴结(不包括DLN)转移、侧颈淋巴结转移的准确性
%(例/例) 淋巴结转移 敏感度 特异度 阳性预测值 阴性预测值 中央区淋巴结(不包括DLN)转移 36.79(39/106) 92.55(87/94) 84.78(39/46) 56.49(87/154) 侧颈淋巴结转移 41.03(16/39) 81.37(131/161) 34.78(16/46) 85.06(131/154)
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