摘要
目的通过研究单侧偏峡部甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者出现对侧中央区淋巴结(contralateral central lymph nodes,Cont-CLNs)转移相关的临床及病理危险因素,建立淋巴结转移预测模型,从而为手术清扫淋巴结的范围提供参考。方法收集江苏大学附属医院2012年2月至2022年6月期间符合入组标准的单侧PTC患者共381例,根据病灶位置分为单侧偏峡部组(n=152)和单侧腺叶组(n=229),对于是否出现Cont-CLNs转移进行相关性分析。对于152例单侧偏峡部组患者,再根据是否出现Cont-CLNs转移进一步分成转移组和未转移组,采用单因素分析研究患者的性别、年龄、病灶分布腺叶、肿瘤大小、肿瘤部位、病理亚型、被膜侵犯、促甲状腺激素(thyroid stimulating hormone,TSH)水平、合并桥本甲状腺炎(Hashimoto’s thyroiditis,HT)、患侧中央区淋巴结(ipsilateral central lymph nodes,Ipsi-CLNs)转移与Cont-CLNs转移的关系。结合单因素分析结果并参考其他文献中相关单侧PTC出现Cont-CLNs转移的高危因素全部纳入logistic多因素分析,得出独立危险因素并建立预测模型。结果相关性分析结果表明,单侧偏峡部组出现Cont-CLNs转移概率高于单侧腺叶组(24.3%比14.4%,χ^(2)=6.009,P=0.014)。进一步的单因素分析结果显示,单侧偏峡部PTC患者出现Cont-CLNs转移与患者的年龄(P=0.02)、肿瘤大小(P<0.01)、被膜受到侵犯(P<0.01)以及存在Ipsi-CLNs转移(P<0.01)具有相关性,与患者性别、腺叶分布、肿瘤部位、病理亚型、TSH水平高低以及是否合并HT无相关性(P>0.05)。logistic多因素分析结果显示:被膜侵犯和Ipsi-CLNs转移是单侧偏峡部PTC患者出现Cont-CLNs转移的独立危险因素;并且上述logistic多因素预测模型经拟合优度Hosmer and Lemeshow检验提示效果良好。结论被膜侵犯和Ipsi-CLNs转移是单侧偏峡部PTC患者出现Cont-CLNs转移的高危因素,建议在临床实践中此类患者在清扫Ipsi-CLNs同时应当预防性行Cont-CLNs清扫。
Objective To analyze the clinical and pathological factors related to the metastasis of contralateral central lymph nodes(Cont-CLNs)in unilateral near isthmus papillary thyroid carcinoma(PTC),and to establish a prediction model of lymph node metastasis,so as to provide reference for the scope of lymph node dissection.Methods A total of 381 unilateral PTC patients from February 2012 to June 2022 were collected in our hospital,and according to the location of the cancer,they were divided into the isthmus group(n=152)and the unilateral glandular lobe group(n=229),and the correlation analysis was performed on whether there was Cont-CLNs metastasis.One hundred and fifty-two patients in the unilateral isthmus PTC group were further divided into metastatic and non metastatic groups based on whether Cont-CLNs metastasis occurred.Univariate analysis was used to analyze the relationship between gender,age,distribution of glandular lobe,tumor size,tumor location,pathological subtype,capsule invasion,thyroid stimulating hormone(TSH)level,combine Hashimoto's thyroiditis(HT),ipsilateral central lymph nodes(IpsiCLNs)metastasis and Cont-CLNs metastasis.According to the univariate analysis results of this study and the possible high-risk factors of contralateral central lymph node metastasis of unilateral thyroid papillary carcinoma in other literatures,they were included in logistic multivariate analysis to obtain independent risk factors and establish a prediction model.Results The incidence of Cont-CLNs metastasis in unilateral isthmus PTC patients was higher than that in nilateral glandular lobe group(24.3%vs.14.4%,χ^(2)=6.009,P=0.014).Univariate analysis showed that Cont-CLNs metastasis in patients with unilateral near isthmus PTC was correlated with age(P=0.02),tumor size(P<0.01),capsule invasion(P<0.01)and Ipsi-CLNs metastasis(P<0.01),but not with gender,distribution of glandular lobe,tumor location,pathological subtype,TSH level and whether to merge HT(P>0.05).Further logistic multivariate analysis suggested that capsule invasion and Ipsi-CLNs metastasis were independent risk factors for Cont-CLNs metastasis in patients with unilateral near isthmus PTC.Moreover,the above logistic multifactor prediction model is proved to be effective by the test of goodness of fit by Hosmer and Lemeshow.Conclusions Capsule invasion and Ipsi CLNs metastasis are high risk factors for Cont-CLNS metastasis in patients with unilateral near isthmus PTC.It is suggested that such patients should be cleaned up with prophylactic Cont-CLNs while cleaning up Ipsi-CLNs.
作者
王林
赵志泓
WANG Lin;ZHAO Zhihong(Department of Thyroid and Breast Surgery,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212000,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2023年第6期709-714,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
甲状腺乳头状癌
单侧偏峡部甲状腺乳头状癌
对侧中央区淋巴结
患侧中央区淋巴结
中央区淋巴结清扫
papillary thyroid carcinoma
unilateral near isthmus papillary thyroid carcinoma
contralateral central lymph node
ipsilateral central lymph nodes
central lymph node dissection
