摘要
目的:探讨峡部甲状腺乳头状癌(PTCI)中央区淋巴结转移规律及其危险因素研究,为PTCI淋巴结清扫范围提供临床依据。方法:回顾性分析2010年06月至2023年06月在山西医科大学第二医院普外科行甲状腺癌根治术治疗的538例甲状腺乳头状癌(PTC)患者的临床资料,根据肿瘤位置分为PTCI组(n=62例)和单侧腺叶PTC组(n=476例),采用独立样本t检验或χ^(2)检验分析PTCI和单侧腺叶PTC患者的一般资料;进一步通过χ^(2)检验分析PTCI和单侧腺叶PTC患者中央区淋巴结转移的差异;采用多因素Logistic回归分析PTCI双侧中央区淋巴结转移的独立影响因素。利用绘制受试者工作特征曲线(ROC)及曲线下面积(AUC)分析肿瘤大小在PTCI患者中的双侧中央区淋巴结(bilateral central lymph nodes,BCLN)转移的预测价值。结果:本研究中,PTCI组和单侧腺叶PTC组相比,在肿瘤大小、淋巴结转移、包膜侵犯、多灶性方面两组有统计学差异(P<0.05);在BCLN清扫术中,PTCI组患者双侧中央区淋巴结转移率高于单侧腺叶PTC组,差异有统计学意义(P<0.05),单侧腺叶PTC组患者单侧中央区高于PTCI组,差异有统计学意义(P<0.05);二元Logistic回归结果显示,峡部肿瘤大小为PTCI患者BCLN转移的独立危险因素(P<0.05)。采用ROC分析PTCI肿瘤大小对BCLN转移的预测价值,AUC为0.807(95%CI:0.670~0.944,P<0.05),最佳临界值(Cut-off值)为0.65 cm,敏感度和特异度分别为90.5%和65%。结论:PTCI患者的肿瘤较小、淋巴结转移率高、包膜侵犯率高、多灶性更常见,且更易出现BCLN转移;PTCI肿瘤大小是BCLN转移的独立影响因素;PTCI癌灶≥0.65 cm时,可预测BCLN转移,应行双侧中央区淋巴结清扫。
Objective:To explore the rule of central zone lymph node metastasis of papillary thyroid carcinoma in the isthmus(PTCI)and its risk factors,and to provide clinical basis for the scope of lymph node dissection in PTCI.Methods:We retrospectively analyzed the clinical data of 538 patients with papillary thyroid carcinoma(PTC)who underwent radical thyroid cancer treatment at the general surgery department of our hospital from June 2010 to June 2023,and classified them into the PTCI group(n=62 cases)and unilateral glandular lobe PTC group(n=476 cases)according to the location of the tumors,and analyzed the general data of the patients with PTCI and unilateral glandular lobe PTC by using the t-test for independent samples or the χ^(2) test.We further analyzed the difference of central regional lymph node metastasis between PTCI and unilateral glandular lobe PTC patients by χ^(2) test,and analyzed the independent influencing factors of bilateral central regional lymph node metastasis of PTCI by multifactorial Logistic regression.The predictive value of tumor size in BCLN metastasis in patients with PTCI was analyzed using plotting the reciver operating characteristic curve(ROC)and area under the curve(AUC).Results:In this study,there were statistically significant differences between the PTCI group and the unilateral glandular lobe PTC group in terms of tumor size,lymph node metastasis,peripheral invasion,and multifocality(P<0.05).In bilateral central lymph node(BCLN)dissection,the rate of bilateral central lymph node metastasis was higher in patients in the PTCI group than in the unilateral glandular lobe PTC group,the difference was statistically significant(P<0.05),and the unilateral central region of patients in the unilateral glandular lobe PTC group was higher than that of the PTCI group,and the difference was statistically significant(P<0.05).The results of binary Logistic regression showed that the size of isthmus tumors was an independent risk factor for BCLN metastasis in patients with PTCI(P<0.05).The predictive value of PTCI tumor size for BCLN metastasis was analyzed using ROC,and the AUC was 0.807(95%C I:0.670~0.944,P<0.05),with an optimal threshold(Cut-off value)of 0.65 cm,and a sensitivity and specificity of 90.5%and 65%,respectively.Conclusion:Patients with PTCI have smaller tumors,higher lymph node metastasis,higher peripheral invasion,more common multifocality,and are more likely to have BCLN metastasis.PTCI tumor size is an independent influencing factor for BCLN metastasis.PTCI cancer focus≥0.65 cm are predictive of BCLN metastasis,and should be subjected to bilateral central lymph node dissection.
作者
王家宝
赵舸
马昕
梁银波
侯春梅
WANG Jiabao;ZHAO Ge;MA Xin;LIANG Yinbo;HOU Chunmei(Shanxi Medical University,Shanxi Taiyuan 030001,China;Department of General Surgery,the Second Hospital of Shanxi Medical University,Shanxi Taiyuan 030001,China)
出处
《现代肿瘤医学》
CAS
2024年第7期1249-1254,共6页
Journal of Modern Oncology
关键词
甲状腺乳头状癌
峡部甲状腺乳头状癌
包膜侵犯
双侧中央区淋巴结
肿瘤大小
papillary thyroid carcinoma
papillary thyroid carcinoma of the isthmus
peritoneal invasion
bilateral central lymph nodes
tumor size
