摘要
目的探讨甲状腺乳头状癌患者颈淋巴结转移的规律及清扫范围。方法回顾性分析笔者所在科室2010年1月～2011年1月初治的166例甲状腺乳头状癌患者的临床资料。研究患者性别、年龄、肿瘤大小和血清TSH与颈淋巴结转移率及转移范围的关系。采用χ2检验、t检验、Logistic模型及ROC曲线进行统计学分析。结果甲状腺乳头状癌淋巴结转移率为46.3%(77/166),年龄<45岁、肿瘤直径>0.5cm是颈淋巴结转移的独立危险因素(比值比分别为4.804和2.018,P均<0.05)。癌灶最大直径与颈部淋巴结转移相关的最佳临界点为0.55cm,敏感性和特异性分别为0.78和0.60,曲线下面积0.741(95%CI:0.667～0.815)。结论甲状腺乳头状癌患者肿瘤直径越大,淋巴结转移的可能就越大,且颈侧区淋巴结转移的可能性也越大,肿瘤直径可作为手术清扫范围的依据。
Objective To discuss the characters of the cervical lymph node metastasis of papillary thyroid carcinoma （PTC） and the extend of thyroidectomy and lymphadenectomy. Methods A total of 166 patients with PTC in our hospital from January 2010 to January 2011 were studied. The statistical correlation between possible factors associated with the presence of lymph node metastases （patients＇ age, sex,tumor size and TSH level） were analyzed with thex2 test,t test, Logistic regression analysis and receiver operating characteristic （ROC） curve analysis. Results The lymph node metastasis incidence was 46.3% （77/166）. Age less than 45 and tumor diameter more than 0.5 cm were independent predictive factors for the lymph node metastasis （ odds ratio was 4. 804 and 2.018, P 〈 0.05, respectively）. The optimal cut - off point which evaluated the tumor diameter as a predictor for lymph node metastasis is 0.55cm with the best sensitivity and specificity （0.78 and 0.60, respectively） and the area under ROC was 0. 741 （95% CI：0. 667 -0. 815）. Conclusion The larger of the tumor size a PTC patient gets, the more possibility of cervical lymph node metastasis will occur. Therefore, the tumor size can be used to determine the extend of thyroidectomy and lymphadenectomy.
出处
《医学研究杂志》
2012年第7期169-171,61,共4页
Journal of Medical Research
关键词
甲状腺肿瘤
甲状腺乳头状癌
淋巴转移
颈淋巴结清扫
血清TSH
Thyroid neoplasms
Papillary thyroid carcinoma （PTC）
Lymphatic metastasis
Radical neck dissection
TSH
