cN<sub>0</sub>甲状腺乳头状癌淋巴结转移的危险因素分析

张　磊; 杨进宝; 樊宇芳

doi:10.3969/j.issn.1007-3969.2016.01.012

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cN₀甲状腺乳头状癌淋巴结转移的危险因素分析

更新时间：2025-12-31

- 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
- 中国癌症杂志 2016年26卷第1期页码：73-79
- 作者机构：
  
  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
- 作者简介：
- 基金信息：
- DOI：10.3969/j.issn.1007-3969.2016.01.012
  中图分类号：
- 网络出版：2016-02-26，
  
  纸质出版：2016-02-26
- 稿件说明：
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张　磊,杨进宝,樊宇芳,等. cN

张　磊, 杨进宝, 樊宇芳. Risk factors of lymph node metastasis in cN₀papillary thyroid carcinoma[J]. China Oncology, 2016, 26(1): 73-79.
张　磊,杨进宝,樊宇芳,等. cN DOI： 10.3969/j.issn.1007-3969.2016.01.012.

张　磊, 杨进宝, 樊宇芳. Risk factors of lymph node metastasis in cN₀papillary thyroid carcinoma[J]. China Oncology, 2016, 26(1): 73-79. DOI： 10.3969/j.issn.1007-3969.2016.01.012.

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，cN

)的甲状腺乳头状癌中并不罕见，该研究旨在探讨cN

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cN

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%，P0.01)、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，P0.001)。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：cN

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。

Abstract

Background and purpose: Pathological lymph node metastasis (LNM) is not rare in clinical lymph node negative (cN

) 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 cN

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 cN

PTC patients. Prophylactic central neck dissection should be performed in cN

patients with tumor size 1 cm. For cN

microcarcinoma

more active surgical treatment may be considered in male and young patients.

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Risk factors of lymph node metastasis in cN0papillary thyroid carcinoma

DOI：10.3969/j.issn.1007-3969.2016.01.012

摘要

Abstract

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Keywords

references

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