甲状腺乳头状癌CN0期患者淋巴结转移危险因素分析

延常姣; 秦元; 凌瑞

doi:10.13201/j.issn.2096-7993.2024.08.007

甲状腺乳头状癌CN0期患者淋巴结转移危险因素分析

- 空军军医大学西京医院甲乳血管外科(西安，710032)
基金项目:
国家自然科学基金(No：82303359)

详细信息

通讯作者: 凌瑞，E-maul：lingruiaoxue@126.com

中图分类号: R736.1

收稿日期: 2023-11-23

刊出日期: 2024-08-03

Analysis of risk factors for lymph node metastasis in patients with CN0 papillary thyroid carcinoma

- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, 710032, China

More Information

Corresponding author: LING Rui, E-mail: lingruiaoxue@126.com

Received Date: 23 November 2023

Publish Date: 03 August 2024

摘要

摘要: 目的探讨CN0期甲状腺乳头状癌(PTC)患者淋巴结转移及多枚淋巴结转移的危险因素。方法回顾性分析2013年1月-2022年12月空军军医大学西京医院行淋巴结清扫的3 099例CN0期PTC患者临床资料，单因素及多因素logistic回归分析淋巴结转移及多枚淋巴结转移的危险因素。结果男性、年龄 < 55岁、多灶病灶、病灶大小>2 cm是CN0期PTC患者淋巴结转移的独立危险因素(P < 0.05)，而合并糖尿病是淋巴结转移的独立保护因素(P < 0.05)。年龄 < 55岁、包膜侵犯、多灶病灶是淋巴结数目≥3枚的独立危险因素(P < 0.05)。结论当CN0期PTC患者为男性、年龄 < 55岁、多灶病灶、病灶大小>2 cm时，要高度警惕淋巴结转移的可能性。
- 甲状腺乳头状癌 /
- 淋巴结转移 /
- 危险因素
Abstract: Objective To explore the risk factors of lymph node metastasis and multiple lymph node metastasis in patients with stage CN0 papillary thyroid carcinoma.Methods The clinical case data of 3 099 patients with CN0 papillary thyroid cancer who underwent lymph node dissection at Xijing Hospital of Air Force Medical University from January 2013 to December 2022 were retrospectively analyzed, univariate and multivariate logistic regression were used to analyze the risk factors of lymph node metastasis and multiple lymph node metastasis.Results Male gender, age < 55 years, multifocal lesions, and lesion size ≥2 cm were independent risk factors for lymph node metastasis in CN0 patients(P < 0.05), while diabetes was an independent protective factor for lymph node metastasis(P < 0.05).Age < 55 years, capsular invasion, and multifocal lesions were independent risk factors for the presence of ≥3 lymph nodes with metastasis (P < 0.05).Conclusion In CN0 stage PTC patients, special attention should be given to the possibility of lymph node metastasis when they are male, aged < 55 years, have multifocal lesions, or have lesion size >2 cm.
- papillary thyroid carcinoma /
- lymph node metastasis /
- risk factors

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表 1 CN0期PTC患者淋巴结转移危险因素单因素分析例(%)

临床病理特征	pN0(n=1793)	pN1(n=1306)	χ²	P
性别			70.735	< 0.001
男	320(17.8)	402(30.8)
女	1 473(82.2)	904(69.2)
年龄			43.056	< 0.001
< 55岁	1 426(79.5)	1155(88.4)
≥55岁	367(20.5)	151(11.6)
有其他肿瘤史	32(1.8)	20(1.5)	0.294	0.672
有家族肿瘤史	167(9.3)	108(8.3)	1.019	0.337
有甲状腺癌家族史	28(1.6)	26(2.0)	0.813	0.405
合并糖尿病	96(5.4)	41(3.1)	8.772	0.003
合并高血压	216(12.0)	134(10.3)	2.407	0.135
合并桥本甲状腺炎	269(15.0)	171(13.1)	2.261	0.144
TSH			0.131	0.744
正常	1 374(85.2)	1003(85.7)
异常	238(14.8)	167(14.3)
Tg			0.446	0.531
阴性	1 133(74.4)	821(73.2)
阳性	390(25.6)	300(26.8)
TgAb			0.003	0.960
阴性	1 279(82.0)	938(82.1)
阳性	281(18.0)	205(17.9)
包膜侵犯	163(9.1)	168(12.9)	11.274	0.001
局部浸润	148(8.3)	155(11.9)	11.188	0.001
病灶大小			33.497	< 0.001
≤2 cm	1 738(96.9)	1206(92.3)
>2 cm	55(3.1)	100(7.7)
病灶数目			16.433	< 0.001
单灶	1 149(64.1)	743(56.9)
多灶	644(35.9)	563(43.1)
病灶分布			14.549	< 0.001
一侧腺叶	1 409(59.8)	384(51.8)
双侧腺叶	949(40.2)	357(48.2)
BRAF V600E基因突变	1174(88.7)	857(89.6)	0.470	0.497
TSH：共2 782例患者有术前TSH结果；Tg：共2 644例患者有术前Tg结果；TgAb：共2 703例患者有术前aTg结果；BRAF V600E：共2 279例患者进行基因检测。

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表 2 CN0期PTC患者淋巴结转移危险因素多因素分析

因素	β	OR	95%CI		P
因素	β	OR	上限	下限	P
性别	-0.754	0.470	0.395	0.560	< 0.001
年龄	-0.678	0.508	0.411	0.628	< 0.001
合并糖尿病	-0.629	0.533	0.359	0.791	0.002
包膜侵犯	0.251	1.285	0.889	1.857	0.182
局部浸润	0.166	1.180	0.803	1.734	0.399
病灶数目	0.275	1.317	1.067	1.625	0.010
病灶分布	0.140	1.151	0.906	1.462	0.251
病灶大小	0.879	2.409	1.699	3.415	< 0.001

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表 3 CN0期PTC患者淋巴结转移数目危险因素单因素分析例(%)

临床病理特征	pN1：1~2枚(n=839)	pN1：3枚及以上(n=467)	χ²	P
性别			7.066	0.009
男	237(28.2)	165(35.3)
女	602(71.8)	302(64.7)
年龄			3.941	0.058
< 55岁	731(87.1)	424(90.8)
≥55岁	108(12.9)	43(9.2)
有其他肿瘤史	12(1.4)	8(1.7)	0.159	0.815
有家族肿瘤史	74(8.8)	34(7.3)	0.937	0.348
有甲状腺癌家族史	15(1.8)	11(2.4)	76.062	< 0.001
合并糖尿病	21(2.5)	20(4.3)	3.125	0.097
合并高血压	89(10.6)	45(9.6)	0.308	0.635
合并桥本甲状腺炎	102(12.2)	69(14.8)	1.807	0.199
TSH			2.863	0.097
正常	641(84.5)	362(88.1)
异常	118(15.5)	49(11.9)
Tg			0.931	0.358
阴性	540(74.2)	281(71.5)
阳性	188(25.8)	112(28.5)
TgAb			2.277	0.147
阴性	615(83.3)	323(79.8)
阳性	123(16.7)	82(20.2)
包膜侵犯	96(11.4)	72(15.4)	4.230	0.047
局部浸润	95(11.3)	60(12.8)	0.667	0.423
病灶大小			4.027	0.051
≤2 cm	784(93.4)	422(90.4)
>2 cm	55(6.6)	45(9.6)
病灶数目			8.280	0.004
单灶	502(59.8)	241(51.6)
多灶	337(40.2)	226(48.4)
病灶分布			4.483	0.038
一侧腺叶	626(74.6)	323(69.2)
双侧腺叶	213(25.4)	144(30.8)
BRAF V600E基因突变^*	571(89.2)	286(90.5)	0.378	0.574
TSH：共1 170例患者有术前TSH结果；Tg：共1 121例患者有术前Tg结果；TgAb：共1 143例患者有术前aTg结果；BRAF V600E：共956例患者进行基因检测。

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表 4 CN0期PTC患者淋巴结转移数目危险因素多因素分析

因素	β	OR	95%CI		P
因素	β	OR	上限	下限	P
性别	-0.245	0.783	0.601	1.020	0.069
年龄	-0.561	0.571	0.375	0.870	0.009
甲状腺癌家族史	0.321	1.379	0.575	3.308	0.472
合并糖尿病	0.495	1.640	0.832	3.235	0.153
TSH	-0.305	0.737	0.512	1.059	0.099
包膜侵犯	0.369	1.446	1.008	2.074	0.045
病灶数目	0.397	1.487	1.054	2.098	0.024
病灶分布	-0.072	0.930	0.637	1.360	0.709
病灶大小	0.316	1.371	0.878	2.142	0.165

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