cN0期甲状腺微小乳头状癌颈部中央区及侧颈区淋巴结转移率、危险因素及清扫策略的临床研究

doi:10.6040/j.issn.1673-3770.0.2023.485

摘要/Abstract

摘要： 目的探讨临床颈部淋巴结阴性(cN0期)甲状腺微小乳头状癌(papillary thyroid microcarcinoma, PTMC)颈部中央区及侧颈区淋巴结转移率、危险因素及清扫策略。方法选择300例行手术治疗的cN0期PTMC患者作为研究对象,收集所有受试对象的一般资料,并对其临床病理资料进行回顾性分析,对可能影响cN0期PTMC淋巴结转移的相关因素进行单因素及多因素Logistic回归分析。结果 300例行手术治疗的cN0期PTMC患者,无淋巴结转移174例(58.00%),有淋巴结转移126例(42.00%)。中央区淋巴结转移118例(39.33%),侧颈区淋巴结转移42例(14.00%),中央区伴侧颈区淋巴结转移34例(11.33%),有侧颈区而无中央区淋巴结转移,即跳跃性转移8例(2.67%)。男性、年龄<45岁、癌灶直径≥0.5 cm、包膜侵犯是PTMC中央区淋巴结转移的独立危险因素(P<0.05)。男性、年龄<45岁、癌灶直径≥0.5 cm、上极肿瘤、包膜侵犯、中央区淋巴结转移是PTMC侧颈区淋巴结转移的独立危险因素(P<0.05)。结论男性、年龄<45岁、癌灶直径≥0.5 cm、包膜侵犯均是PTMC中央区和侧颈区淋巴结转移的独立危险因素,其中侧颈区淋巴结转移的独立危险因素还包括上极肿瘤与中央区淋巴结转移,临床上可据此判断淋巴结转移区域,针对性采取相应的清扫策略,以改善患者预后。

关键词: 甲状腺微小乳头状癌, cN0期, 淋巴结转移, 危险因素, 清扫策略

Abstract: Objective To investigate the lymph node metastasis rate, risk factors and dissection strategy in the central and lateral cervical region of lymph node negative(cN0 stage)papillary thyroid microcarcinoma(PTMC). Methods 300 patients with stage cN0 PTMC who underwent surgical treatment were selected as the study objects. General data of all patients were collected and their clinicopathological data were retrospectively analyzed. The related factors that may affect cN0 stage PTMC lymph node metastasis were analyzed by method of univariate and multivariate Logistic regression analysis. Results Among 300 patients with cN0 stage PTMC undergoing surgical treatment, 174 cases(58.00%)had no lymph node metastasis and 126 cases(42.00%)had lymph node metastasis. There were 118 cases(39.33%)of central lymph node metastasis, 42 cases(14.00%)of lateral lymph node metastasis, 34 cases(11.33%)of central with lateral lymph node metastasis, 8 cases(2.67%)with lymph node metastasis in lateral cervical region but not central region, i.e. skipping lymph node metastasis. For male, age <45 years, tumor diameter ≥0.5 cm, capsular invasion was independent risk factor for central lymph node metastasis of PTMC(P<0.05). For male, age <45 years, tumor diameter ≥0.5 cm, upper pole tumor, capsular invasion and central lymph node metastasis were independent risk factors for lymph node metastasis in the lateral cervical region of PTMC(P<0.05). Conclusion For male, age <45 years old, tumor diameter ≥0.5 cm, capsular invasion are all independent risk factors for central and lateral lymph node metastasis of PTMC. The independent risk factors for lateral lymph node metastasis also include upper pole tumor and central lymph node metastasis. In clinical practice, this can be used to determine the area of lymph node metastasis and adopt targeted dissection strategies to improve the prognosis in patients.

Key words: Papillary thyroid microcarcinoma, Stage cN0, Lymph node metastasis, Risk factor, Dissection strategy

中图分类号:

R736.1

张琳,辛运超,尚小领,解琪,刘亚超. cN0期甲状腺微小乳头状癌颈部中央区及侧颈区淋巴结转移率、危险因素及清扫策略的临床研究[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 62-69.

ZHANG Lin, XIN Yunchao, SHANG Xiaoling, XIE Qi, LIU Yachao. A clinical study of lymph node metastasis rate, risk factors and dissection strategy in the central and lateral cervical region of stage cN0 papillary thyroid microcarcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 62-69.

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