中国癌症杂志 ›› 2017, Vol. 27 ›› Issue (1): 26-30.doi: 10.19401/j.cnki.1007-3639.2017.01.005

• 论著 • 上一篇    下一篇

甲状腺乳头状癌淋巴结转移率和远处转移的关系

高 文1,2,梁 军3,李小毅4,赵 腾2,王 宸1,林岩松1   

  1. 1. 中国医科院学院,北京协和医学院,北京协和医院核医学科,北京 100730 ;
    2. 青岛大学附属医院肿瘤科,山东 青岛 266003 ;
    3. 北京大学国际医院肿瘤科,北京 102206 ;
    4. 中国医科院学院,北京协和医学院,北京协和医院基本外科,北京 100730 ;
  • 出版日期:2017-01-30 发布日期:2017-02-23
  • 通信作者: 林岩松 E-mail:linys@pumch.cn
  • 基金资助:
    国家自然科学基金(81571714);卫生部行业科研专项项目(201202012)。

The relationship between the rate of involved lymph nodes and distant metastasis in papillary thyroid carcinoma

GAO Wen1,2, LIANG Jun3, LI Xiaoyi4, ZHAO Teng2, WANG Chen1, LIN Yansong1   

  1. 1. Department of Nuclear Medicine, PUMC Hospital, CAMS and PUMC, Beijing 100730, China; 2. Department of Oncology, the Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China; 3. Department of Oncology, Peking University International Hospital, Beijing 102206, China; 4. Department of General Surgery, PUMC Hospital, CAMS and PUMC, Beijing 100730, China
  • Published:2017-01-30 Online:2017-02-23
  • Contact: LIN Yansong E-mail: linys@pumch.cn

摘要: 背景与目的:颈部淋巴结转移在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中多见。该研究旨在探讨PTC淋巴结转移率(the rate of involved lymph nodes,LR)与远处转移(distant metastasis,DM)的关系,及其对DM的预测价值。方法:随访162例PTC患者,将其分为DM组(M1组)41例和非DM组(M0组)121例,采用t检验、χ2检验分别比较两组患者的基本病理特征。采用多因素分析评估LR在预测DM的意义。利用受试者工作特征(receiver operating characteristic curve,ROC)曲线及最佳诊断界值点评估LR及淋巴结转移数目(the number of involved lymph nodes,LNs)对DM的预测价值,进一步采用Kaplan-Meier曲线评估LR及LNs发生DM的累积风险,使用Log-rank法对差异进行统计学分析。结果:两组患者在年龄及多灶性方面差异无统计学意义(P>0.05),在男性(χ2=13.039,P=0.000)、腺外侵犯(χ2=2.941,P=0.000)、病灶大小(t=-4.485,P=0.000)方面存在显著差异。LR可以作为预测DM的独立因素(OR=1.133,P=0.000)。随着LR的增高,LNs大于等于15组患者的DM风险显著高于LNs小于15组(P=0.0002)。结论:LR可作为DM的独立预测指标,其与LNs结合可以更好地预测DM的发生风险。

关键词: 甲状腺乳头状癌, 淋巴结转移率, 淋巴结转移数目, 远处转移

Abstract: Background and purpose: Lymph node metastasis commonly occurs in papillary thyroid carcinoma (PTC). The object of this study was to investigate the relationship between the rate of involved lymph nodes (LR) and distant metastasis (DM) in PTC, and its potential value in predicting the risk of DM. Methods: PTC patients were divided into two groups as M0 (121 cases) and M1 (41 cases) according to the presence of distant metastases or not. The t-text and χ2 test were used to evaluate the statistical differences in basic clinicopathological features between the two groups. Multivariate analysis was used to quantify LR as an independent factor of DM. The receiver operating characteristic (ROC) curve was employed to evaluate the clinical value of LR and the number of involved lymph node (LNs) for predicting DM and optimal cut-off point respectively. The cumulative risk of distant metastasis curves according to the LR and LNs status were constructed with the Kaplan-Meier method, and the Log-rank test was used to compare these curves. Results: There were no statistical differences in age and multifocality between two groups (P>0.05), while significant differences in gender, extrathyroidal invasion and tumor size were observed. LR is an independent indicator for predicting DM (OR=1.133, P=0.000). An increase in LR was significantly associated with DM. Patients with more than 15 involved LNs had the steepest increasing pattern in the cumulative risk of DM compared with those who had less than 15 involved LN (P=0.002). Conclusion: LR may be an independent predictive marker for distant metastases in PTC, and its combination with LNs might better predict the risk of DM.

Key words: Papillary thyroid carcinoma, The rate of involved lymph nodes, The number of involved lymph nodes, Distant metastasis