甲状腺乳头状癌中央区淋巴结转移的危险因素分析

Risk factors for central neck lymph node metastases of papillary thyroid carcinoma

摘要:

目的 探讨甲状腺乳头状癌（PTC）中央区淋巴结转移（CLNM）的危险因素。方法 选取 2016 年8 月—2018 年12 月在锦州医科大学附属第一医院行手术治疗的303 例PTC 患者临床资料，回顾性 分析患者性别、年龄、体重指数（BMI）、肿瘤最大直径、肿瘤数量、肿瘤位置、被膜侵犯情况、甲状腺 球蛋白抗体（TgAb）及促甲状腺激素（TSH）等因素对CLNM 的影响。结果 303 例患者中，116 例发生 CLNM，总转移率为39.27%。单因素分析结果显示，性别、年龄、BMI、肿瘤最大直径、肿瘤数量、是否 被膜侵犯及CLNM 率比较，差异有统计学意义（P <0.05）。多因素Logistic 回归分析显示，性别[Ol ^ R=0.454 （95% CI ：0.224，0.921）]、年龄[Ol ^ R=0.957（95% CI ：0.936，0.978）]、肿瘤最大直径[Ol ^ R=1.438（95% CI ： 1.117，1.852）] 及被膜侵犯[Ol ^ R=0.399（95% CI ：0.230，0.691）] 是PTC 患者发生CLNM 的危险因素。受 试者工作特征曲线显示，年龄为45.5 岁、肿瘤最大直径为0.75cm 时约登指数最大，对应的曲线下面积分别为 0.643 和0.691，敏感性分别为0.620（95% CI ：0.580，0.706）和0.695（95% CI ：0.632，0.750），特异性分别为 0.682（95% CI ：0.580，0.706）和0.720（95% CI ：0.632，0.750）。结论 PTC 发生CLNM 与多个因素有关， 当患者为男性、年龄<45.5 岁、肿瘤最大直径≥ 0.75 cm 及存在被膜侵犯时，CLNM 发生可能性大，建议行 中央区淋巴结清扫。

Abstract:

Objective To investigate the risk factors of central lymph node metastasis (CLNM) in papillary thyroid carcinoma (PTC). Methods The clinical data of 303 patients with PTC who underwent surgical treatment in our hospital from August 2016 to December 2018 were collected. The influence of sex, age, body mass index (BMI), tumor maximum diameter, tumor number, tumor location, membrane infiltration, thyroglobulin antibody (TgAb) and thyroid stimulating hormone (TSH) on CLNM in PTC were retrospectively analyzed. Results The total metastatic rate of CLNM was 39.27% in 116 out of 303 patients. Univariate results showed that sex, age, BMI, tumor maximum diameter, number of tumors and membranous infiltration were associated with CLNM. The differences were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that sex [Ol ^ R = 0.454, (95% CI: 0.224, 0.921)], age [Ol ^ R = 0.957, (95% CI: 0.936, 0.978)] , tumor maximum diameter [Ol ^ R = 1.438, (95% CI: 1.117, 1.852)] and the membrane infiltration [Ol ^ R = 0.399, (95% CI: 0.230, 0.691)] were risk factors for CLNM in patients with PTC. Subject operating characteristic curve (ROC) analysis showed that the Yoden index was the largest when the age was 45.5 years old and the maximum diameter of the tumor was 0.75cm. The area under the curve were 0.643 and 0.691; sensitivity was 0.526 (95% CI: 0.580, 0.706) and 0.845 (95% CI: 0.632, 0.750); specificity was 0.711 (95%CI: 0.580, 0.706) and 0.471 (95% CI: 0.632, 0.750), respectively. Conclusions The occurrence of CLNM in PTC is related to several factors. When the patient is male, age < 45.5, tumor maximum diameter ≥ 0.75 cm and membranous infiltration, CLNM is more likely to occur and it is recommended that the central lymph node dissection (CLND) should be performed.