甲状腺乳头状癌右侧喉返神经深层（Ⅵb区）淋巴结转移的风险分析

Risk analysis of deep surface lymph node metastasis (Ⅵb) of right recurrent laryngeal nerve in papilllary thyroid carcinoma

摘要:

目的 探讨甲状腺乳头状癌（PTC）患者发生右侧喉返神经深层（ⅥⅥb区）淋巴结转移的危险性。方法 收集锦州医科大学附属第一医院2018年1月—2019年4月收治的175例PTC患者的临床资料，回顾性分析PTC患者右侧喉返神经浅层（Ⅵa区）及Ⅵb区发生淋巴结转移在不同临床病理特征间的差异性。结果 175例PTC患者中，发生Ⅵa区淋巴结转移67例，Ⅵb区淋巴结转移29例，兼有Ⅵa、Ⅵb区淋巴结转移23例。单因素分析和多因素Logistic回归分析结果显示，年龄、癌灶最大径、癌灶多发性、颈侧区淋巴结转移（LLNM）是Ⅵa区淋巴结转移的独立危险因素；癌灶最大径、右侧癌灶、LLNM、Ⅵa区淋巴结转移是Ⅵb区淋巴结转移的独立危险因素；列线图显示，癌灶最大径和癌灶位置对Ⅵb区淋巴结转移的影响最大，年龄、LLNM和Ⅵa区淋巴结转移的影响次之，癌灶多发性的影响最小。受试者工作特征曲线显示，Ⅵb区淋巴结转移的独立危险因素中癌灶最大径的诊断截断值为0.75 cm。结论 PTC患者癌灶最大径、右侧癌灶、LLNM或Ⅵa区淋巴结转移为Ⅵb区淋巴结转移的独立危险因素。且可以根据列线图计算出PTC患者发生Ⅵb区淋巴结转移的概率。PTC患者存在这些危险因素且列线图评分较高时，发生Ⅵb区淋巴结转移的风险增加。

Abstract:

Objective To analyze the risk of deep surface (Ⅵb) lymph node metastasis of right recurrent laryngeal nerve in papillary thyroid carcinoma (PTC) patients.Methods A total of 175 PTC patients who underwent total thyroidectomy or lobectomy plus pCLND in the First Affiliated Hospital of Jinzhou Medical University from January 2018 to April 2019 were retrospectively analyzed. The clinicalpathology features were assessed for the impact on Ⅵa and Ⅵb lymph node metastasis of PTC patients.Results Among 175 PTC patients, 67 had Ⅵa lymph node metastasis, 29 had Ⅵb lymph node metastasis, 23 had both Ⅵa and Ⅵb lymph node metastasis. Univariate and multivariate logistic analyses found that age, maximal tumor size, multifocal lesions and lateral lymph node metastasis (LLNM) were independent risk factors of Ⅵa lymph node metastasis in PTC patients. The independent risk factors of Ⅵb lymph node metastasis included maximal tumor size, right tumor location, LLNM, and Ⅵa lymph node metastasis through analysis. The nomogram showed maximal tumor size and right tumor location as the largest contributor to points, followed by age, LLNM, Ⅵa lymph node metastasis. And multifocal lesions had a poor influence on the points. The cut-off point of maximal tumor size in the independent risk factors of Ⅵb lymph node metastasis was greater than 0.75 cm by drawing ROC curve.Conclusions PTC patients with maximal tumor size, right tumor location, LLNM, and Ⅵa lymph node metastasis were independent risk factors of Ⅵb lymph node metastasis. The probability of Ⅵb lymph node metastasis can be calculated using nomogram. PTC patients presenting with these risk factors and high nomogram probability had a high risk of Ⅵb lymph node metastasis.