cN0甲状腺乳头状癌淋巴结转移的危险因素分析

doi:10.3969/j.issn.1007-3969.2016.01.012

中国癌症杂志 ›› 2016, Vol. 26 ›› Issue (1): 73-79.doi: 10.3969/j.issn.1007-3969.2016.01.012

cN₀甲状腺乳头状癌淋巴结转移的危险因素分析

张　磊¹，杨进宝²，樊宇芳³，孙庆贺¹，谢　勇¹，刘洪¹，高维生¹，李小毅^1*

1. 中国医学科学院北京协和医院基本外科，北京 100730 ；
2. 白求恩和平医院普外二科，河北石家庄 050082 ；
3. 山西省肿瘤医院放疗科，山西太原 030000

出版日期:2016-01-30 发布日期:2016-02-26
通信作者: 李小毅　E-mail:li.xiaoyi@263.net

Risk factors of lymph node metastasis in cN₀papillary thyroid carcinoma

ZHANG Lei¹, YANG Jinbao², FAN Yufang³, SUN Qinghe¹, XIE Yong¹, LIU Hongfeng¹, GAO Weisheng¹, LI Xiaoyi¹

1.Department of General Surgery, Peking Union Medical College Hospital, Beijing 100730, China; 2. Second Department of General Surgery, Bethune International Peace Hospital, Shijiazhuang 050082, Hebei Province, China; 3. Department of Radiotherapy, Shanxi Cancer Hospital, Taiyuan 030000, Shanxi
Province, China

Published:2016-01-30 Online:2016-02-26
Contact: LI Xiaoyi E-mail: li.xiaoyi@263.net

摘要/Abstract

摘要：

背景与目的：术后病理证实的淋巴结转移在临床淋巴结转移阴性(clinical lymph node negative，cN₀)的甲状腺乳头状癌中并不罕见，该研究旨在探讨cN₀甲状腺乳头状癌淋巴结转移的危险因素，特别是大量淋巴结转移(>5个)、单侧单发癌灶对侧中央区转移的危险因素。方法：收集北京协和医院2008年—2014年由同一手术团队实施手术的cN₀甲状腺乳头状癌患者350例(男性85例，女性265例；其中单侧单发癌灶212例)。分析患者的临床病理学特征，通过单因素、多因素分析寻找淋巴结转移的危险因素。结果：350例患者中共出现淋巴结转移138例(39.4%)，大量淋巴结转移20例(5.7%)，在单侧单发癌灶且行双侧腺体切除联合双侧中央区淋巴结清扫的169例患者中，24例出现对侧中央区淋巴结转移(14.2%)。淋巴结转移的危险因素的单因素分析中，肿物大小小于等于1 cm和大于1 cm(33.6% vs 58.5%，P<0.01)、超声肿物有钙化和无钙化者(31.7% vs 43.7%，P=0.03)淋巴结转移差异有统计学意义；多因素分析中，非微小癌是淋巴结转移的独立危险因素(OR=2.792，P<0.001)。出现大量淋巴结转移危险因素的单因素分析中，女性和男性(3.8% vs 11.8%，P=0.012)、年龄小于40岁和大于等于40岁(10.7% vs 3.4%，P=0.006)、肿物大小小于等于1 cm和大于1 cm(3.4% vs 13.4%，P=0.002)、超声肿物低回声和非低回声(13.9% vs 4.8%，P=0.026)者在有无大量淋巴结转移上差异有统计学意义；多因素分析中，男性(OR=5.152，P=0.002)、非微小癌(OR=5.712，P=0.001)、年龄小于40岁(OR=3.959，P=0.006)是大量淋巴结转移的独立危险因素。男性(OR=3.105，P=0.022)、非微小癌(OR=3.863，P=0.008)是单侧单发癌灶对侧中央区淋巴结转移的独立危险因素，其对侧中央区淋巴结转移率分别为26.5%、26.1%。结论：cN₀甲状腺乳头状癌出现淋巴结转移的比例较高；对于其中非微小甲状腺乳头状癌应常规行中央区淋巴结清扫，对于男性、年
龄小于40岁的微小甲状腺乳头状癌也应考虑采取积极的手术方式。

关键词: 甲状腺乳头状癌, 临床淋巴结转移阴性, 淋巴结转移, 危险因素

Abstract: Background and purpose: Pathological lymph node metastasis (LNM) is not rare in clinical lymph node negative (cN₀) papillary thyroid carcinoma (PTC). The aim of this study was to investigate the risk factors of LNM, especially of high volume LNM (more than 5 metastatic lymph nodes) and contralateral central compartment LNM, in cN₀ PTC. Methods: Medical records of 350 PTC patients (265 female, 85 male, 212 patients with solitary lesion in unilateral lobe) were reviewed. All operations of these patients were performed by one surgical team. The clinical pathological data were collected, and univariate and multivariate analysis was performed. Results: LNM was confirmed in 138 patients (39.4%) and 20 patients had high volume LNM. In 169 patients with solitary lesion in unilateral lobe with total thyroidectomy and bilateral central neck dissection, 24 patients had contralateral metastasis (14.2%). In univariate analysis, tumor size (58.5% in >1 cm vs 33.6% in ≤1 cm) and tumor with calcification in preoperational ultrasonography (43.7% with vs 31.7% without) showed significant difference in prevelance of LNM. In multivariate analysis, tumor size >1 cm (OR=2.792) was the independent risk factor of LNM. Gender (3.8% in male vs 11.8% in female), age (10.7% <40 years vs 3.4% ≥40 years ), tumor size(13.4% in >1 cm vs 3.4% in ≤1 cm) and tumor with low echo in preoperational ultrasonography (13.9% with vs 4.8% without) showed significant difference in univariate analysis of high volume LNM. Male (OR=5.152), tumor size >1 cm (OR=5.712) and age <40 years (OR=3.959) were confirmed as independent risk factors of high volume LNM. Male (OR=3.105) and tumor size >1 cm (OR=3.863) were also demonstrated as independent risk factors of contralateral LNM in patients with solitary lesion in unilateral lobe, the prevalence of LNM were 26.5% in male and 26.1% in tumor size >1 cm, respectively. Conclusion: LNM was not “rare” in cN₀ PTC patients. Prophylactic central neck dissection should be performed in cN₀ patients with tumor size >1 cm. For cN₀microcarcinoma, more active surgical treatment may be considered in male and young patients.

Key words: Papillary thyroid carcinoma, Clinical lymph node negative, Lymph node metastasis, Risk factor

张　磊,杨进宝,樊宇芳,等. cN₀甲状腺乳头状癌淋巴结转移的危险因素分析[J]. 中国癌症杂志, 2016, 26(1): 73-79.

ZHANG Lei, YANG Jinbao, FAN Yufang, et al. Risk factors of lymph node metastasis in cN₀papillary thyroid carcinoma[J]. China Oncology, 2016, 26(1): 73-79.

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cN₀甲状腺乳头状癌淋巴结转移的危险因素分析

Risk factors of lymph node metastasis in cN₀papillary thyroid carcinoma

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