摘要
目的探讨多发癌灶对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)临床病理特征及中央区淋巴结转移的影响。方法 PTC患者838例,根据癌灶数目是否≥2个分为多灶组283例和单灶组555例,比较2组临床和病理资料,分析多灶组发生中央区淋巴结转移与临床病理特征间的关系,采用多因素logistic回归分析多灶性PTC发生中央区淋巴结转移的危险因素。结果多灶组患者年龄、性别比例、术前促甲状腺激素释放激素水平、肿瘤最大径及腺外侵犯比率、伴有钙化灶比率与单灶组比较差异无统计学意义(P>0.05),多灶组患者体质量指数[(25.25±4.18)kg/cm2]、癌结节形态不规则比率(85.5%)、边界不清比率(84.1%)、含微小癌灶比率(68.2%)、合并桥本氏甲状腺炎(Hashimoto's thyroiditis,HT)比率(32.2%)、双侧癌发生率(79.9%)、总淋巴结转移率(54.8%)、中央区淋巴结转移率(54.8%)、TNM分期Ⅲ期比率(17.7%)和Ⅳ期比率(6.7%)均高于单灶组[(24.40±3.43)kg/cm2、79.1%、75.5%、58.9%、19.8%、0、35.7%、33.0%、10.3%、4.5%](P<0.05);多灶组发生中央区淋巴结转移者肿瘤最大径[(1.23±1.16)cm]及合并HT发生率(67.0%)高于无中央区淋巴结转移者[(0.89±0.09)cm、33.0%](P<0.05);肿瘤最大径增大(OR=1.959,95%CI:1.135~3.379,P=0.016)和合并HT(OR=2.072,95%CI:1.214~3.536,P=0.008)是多灶性PTC发生中央区淋巴结转移的独立危险因素。结论多灶性PTC多见于双侧甲状腺,常含有微小癌灶,易合并HT及中央区淋巴结转移;肿瘤最大径增大和合并HT是多灶性PTC发生中央区淋巴结转移的独立危险因素。
Objective To investigate the influence of multifocal papillary thyroid carcinoma （PTC） on clinicopathological features and central lymph node metastasis. Methods A total of 838 patients with PTC were divided into multifocal group （≥ 2 loci, n=283） and solitary group （n= 555） according to the loci number. The clinical and pathological data were compared between two groups. The relationship between central lymph node metastasis and clinical pathological features was analyzed in multifocal group. Multivariate logistic regression was used to analyze the risk factors for central lymph node metastasis in multifocal PTC. Results There were no significant differences in the age, gender, thyroid stimulating hormone level, maximum tumor diameter, tumor invasion proceeding beyond the thyroid or not, and complicated with or with not calcification between multifocal group and solitary group （P〉0.05）. The body mass index （（25. 25 ± 4.18） kg/em2）, and rates of irregular carcinoma nodules （85.5 %）, unclear boundary （84.1%）, minimal carcinoma loci （68. 2%）, Hashimoto＇s thyroiditis （32. 2%）, bilateral thyroid carcinoma （79. 9%）, total lymph node metastasis （54.8%）, central lymph node metastasis （54.8%）, TNM stage Ⅲ （17.7%） and stage Ⅳ （6.7%） in multifocal group were significantly higher than those in solitary group （（24.40± 3.43） kg/cm2 , 79.1%, 75.5%, 58.9%, 19.8%, 0, 35.7%, 33.0%, 10.3%, 4.5%） （P〈0.05）. The maximum tumor diameter was significantly longer and the incidence of Hashimoto＇s thyroiditis was significantly higher in patients with central lymph node metastasis （（1.23±1. 16） cm, 67.0%） than those in patients with no central lymph node metastasis （（0.89±0.69） cm, 33.0%） in multifocal group （P〈0.05）. The increased maximum tumor diameter （OR=1. 959, 95%CI： 1. 135-3. 379, P=0. 016） and incidence of Hashimoto＇s thyroiditis （OR=2. 072, 95%CI： 1. 214-3. 536, P=0. 008） were the independent risk factors for central lymph node metastasis in multifocal group. Conclusion Multifocal PTC is more common in bilateral thyroid, containing minimal cancer loci, and is easily complicated with Hashimoto＇s thyroiditis and central cervical lymph node metastasis. The increased maximum tumor diameter and complication of Hashimoto＇s thyroiditis are the independent risk factors for central lymph node metastasis in multifocal PTC.
出处
《中华实用诊断与治疗杂志》
2018年第2期128-131,共4页
Journal of Chinese Practical Diagnosis and Therapy
基金
新疆维吾尔自治区自然科学基金(2016D01C298)
关键词
甲状腺乳头状癌
多灶性
中央区淋巴结
淋巴结转移
危险因素
Papillary thyroid carcinoma
multifocal
central lymph mode
lymph node metastasis
risk factor
