合并慢性淋巴细胞性甲状腺炎的甲状腺乳头状癌的临床病理特点及淋巴结转移风险分析被引量：18

Clinicopathologic features and risk factors for lymph node metastasis of papillary thyroid carcinoma with chronic lymphocytic thyroiditis

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摘要目的探讨合并慢性淋巴细胞性甲状腺炎(chronic lymphocytic thyroiditis,CLT)的甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理特点及淋巴结转移风险。方法连续收集2013年10月至2015年10月期间在北京协和医院行手术治疗、经病理确诊的4265例PTC患者的临床病理资料,分析其临床病理特点,确定临床病理特征是否是淋巴结转移的独立危险因素。结果4265例PTC患者中,甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)3059例(71.7%),伴CLT者1010例(23.7%).合并CLT的PTC患者中,女性909例(90%)、中位数年龄43岁、中位肿瘤长径0.8cm、多发病灶624例(61.8%),被膜侵犯422例(41.8%),淋巴结转移429例(42.5%),大量淋巴结转移133例(13.2%)。与未合并CLT的PTC患者相比,合并CLT的PTC患者,女性比例多(90.0%比70.2%,P<0.001);中位年龄低(43岁比44岁,P=0.001);淋巴结转移率低(42.5%比50.9%,P<0.001);肿瘤长径、多发病灶比例、被膜侵犯率、大量淋巴结转移率并无显明差异(0.8cm比0.7cm,61.8%比62.9%,41.8%比42.1%,13.2%比14.5%,均P>0.05)o淋巴结转移多因素分析显示:CLT是PTC淋巴结转移的独立保护因素(OR=0.713,95%CI 0.609-0.835,P<0.001),但不是大量淋巴结转移的独立保护因素(OR=0.944,95%CI 0.750-1.188,P=0.621)。结论CLT是PTC淋巴结转移的独立保护因素,但是发生转移的患者其淋巴结转移数量并未减少。 Objective To summarize clinicopathologic features of papillary thyroid carcinoma (PTC) coexistent with chronic lymphocytic thyroiditis ( CLT) and investigate risk factors for lymph node metastasis. Methods The medical records of 4 264 consecutive papillary thyroid carcinoma patients who received surgical treatment from Oct 2013 to Oct 2015 in Peking Union Medical College Hospital were reviewed. The diagnoses was confirmed by histopathological tests. Univariate analysis was performed to identify specific clinicopathologic features of PTC with CLT. Univariate and multivariate analysis were performed to determine whether each clinicopathologic feature was an independent risk factor for lymph node metastasis. Results In all 4 265 cases, there were 3 059 papillary thyroid microcarcinoma ( PTMC )(71. 7%), 1 010 PTC patients (23. 7%) with CLT. 909 female patients (90%), 624 cases with multifocal lesions (61.8%), 422 cases with extra-thyroid extension (41. 8%), 429 cases with lymph node metastasis (42. 5%), and 133 cases with metastatic lymph nodes( LNs)≥6 (13. 2%). The median age was 43 years old and median tumor size was 0. 8 cm. Patients with CLT were more females ( 90. 0% vs. 70. 2%;P < 0. 001 ), younger median age (43 vs. 44 years;P =0. 001 ), and lower incidence of lymph node metastasis (42. 5% vs. 50. 9%;P <0. 001). CLT was not associated with tumor size, multifocal lesions, extra-thyroid extension and metastatic LNs(0. 8 cm vs. 0. 7 cm, 61. 8% vs. 62. 9%, 41. 8% vs. 42. 1% and 13. 2% vs. 14. 8%, respectively, all P>0. 05). In multivariate analysis, CLT was an independent protective factor for lymph node metastasis ( OR =0. 713 , 95% CI 0. 609-0. 835 , P <0. 001 ). In PTC patients with lymph node metastasis, CLT was not associated with lymph node metastasis number ( 3 vs. 3 , P = 0. 300 ). Conclusions Chronic lymphocytic thyroiditis was an independent protective factor for papillary thyroid carcinoma patients with lymph node metastasis. But in patients with lymph node metastasis, the metastatic number didn't decrease.

作者董云伟刘春浩胡神保张磊杨进宝刘跃武梁峰石华刘子文陈革陈曙光商中华孙庆贺李延龙李小毅 Dong Yunwei;Liu Chunhao;Hu Shenbao;Zhang Lei;Yang Jinbad;Liu Yuewu;Liang Feng;Shi Hua;Liu Ziwen;Chen Ge;Chen Shuguang;Shang Zhonghua;Sun Qinghe;Li Yanlong;Li Xiaoyi(Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730,China;Department of General Surgery, People rsLiberation Army Bethune International Peace Hospital, Shijiazhuang 050082 , China;Department of General Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075061,China;GeneralSurgery Department,Sixth People's Hospital of Hengshui, Hengshui 053200, China;General Surgery Department ,Second Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of Epidemiology and Health Statistics,Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences,School of Basic Medicine, Peking Union Medical College, Beijing 100730,China)