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山东大学学报 (医学版) ›› 2023, Vol. 61 ›› Issue (2): 57-64.doi: 10.6040/j.issn.1671-7554.0.2022.1004

• 临床医学 • 上一篇    下一篇

934例甲状腺微小乳头状癌颈淋巴结部位转移及危险因素

邵长秀1,2,贺青卿2,庄晓璇3,李小磊2,周鹏2,岳涛2,高远2,4,徐婧2,李陈钰1,2,郭浩男1,2,庄大勇2   

  1. 1.锦州医科大学中国人民解放军联勤保障部队第九六〇医院研究生培养基地, 山东 济南 250031;2.中国人民解放军联勤保障部队第九六〇医院甲状腺乳腺外科, 山东 济南 250031;3.重庆医科大学国际医学院, 重庆 400016;4.中国人民解放军联勤保障部队第九六三医院, 黑龙江 佳木斯 154002
  • 发布日期:2023-02-17
  • 通讯作者: 庄大勇. E-mail:zdyddy2000@TOM.com

Patterns and risk factors of cervical lymph node metastasis in 934 cases of papillary thyroid microcarcinoma

SHAO Changxiu1,2, HE Qingqing2, ZHUANG Xiaoxuan3, LI Xiaolei2, ZHOU Peng2, YUE Tao2, GAO Yuan2,4, XU Jing2, LI Chenyu1,2, GUO Haonan1,2, ZHUANG Dayong2   

  1. 1. Postgraduate Training Base of the 960th Hospital of PLA Joint Logistics Support Force of Jinzhou Medical University, Jinan 250031, Shandong, China;
    2. Department of Thyroid and Breast Surgery, The 960th Hospital of PLA Joint Logistics Support Force, Jinan 250031, Shandong, China;
    3. International Medical College of Chongqing Medical University, Chongqing 400016, China;
    4. The 963th Hospital of PLA Joint Logistics Support Force, Jiamusi 154002, Heilongjiang, China
  • Published:2023-02-17

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摘要： 目的 探讨甲状腺微小乳头状癌(PTMC)颈部淋巴结转移规律及危险因素分析, 为合理、规范的外科手术提供临床依据。 方法 回顾性分析2019年1月至2021年12月解放军第九六〇医院病理科接收的行颈侧区淋巴结清扫的甲状腺微小乳头状癌患者934例病理资料。统计患者颈部淋巴结转移情况,分析患者不同临床特征与颈部淋巴结转移之间的关系以及颈部淋巴结转移的危险因素。 结果 934例甲状腺微小乳头状癌患者中,颈部淋巴结(中央区和/或颈侧区)转移率50.64%(473/934),中央区淋巴结转移率47.86%(447/934),颈侧区淋巴结转移率20.77%(194/934)。447例中央区转移患者中168例(37.58%)合并颈侧区淋巴结转移。颈侧区淋巴结转移而中央区无转移率2.78%(26/934)。卡方检验分析显示,男性、肿瘤直径>0.55cm、包膜侵犯、双侧、多灶的PTMC患者颈部淋巴结、颈部中央区淋巴结、颈侧区淋巴结转移率高(P<0.05),不合并桥本甲状腺炎的PTMC患者颈部及颈部中央区淋巴结转移率高(P<0.05),特殊病理类型的PTMC患者颈部及颈侧区淋巴结转移率高(P<0.05);二分类Logistic多因素回归分析显示,男性、肿瘤直径>0.55 cm、双侧、不合并桥本甲状腺炎是颈部及颈部中央区淋巴结转移的独立危险因素;肿瘤直径>0.55 cm、包膜侵犯、特殊病理类型为颈侧区淋巴结转移的独立危险因素。单病灶甲状腺微小乳头状癌患者肿瘤位置位于上部及峡部时侧区淋巴结转移率高于中部和下部。 结论 PTMC患者中央区淋巴结转移率高,应常规行中央区淋巴结清扫。当PTMC患者存在肿瘤直径>0.55 cm、包膜侵犯、特殊病理类型、肿瘤位于上部或峡部时,颈侧区淋巴结转移风险增高,可考虑行颈侧区淋巴结清扫。

关键词: 甲状腺微小乳头状癌, 颈部淋巴结转移, 转移率, 危险因素

Abstract: Objective To explore the patterns and risk factors of cervical lymph nodes metastasis(LNM)of papillary thyroid microcarcinoma(PTMC), in order to provide clinical evidences for reasonable and standardized surgical procedures. Methods Pathological data of 934 PTMC patients who underwent lateral lymph node dissection during Jan. 2019 and Dec. 2021 were retrospectively analyzed. The cervical LNM data were collected. The relationship between cervical LNM and different clinical characteristics and risk factors of LNM were analyzed. Results Among the 934 patients, the rate of central and/or lateral LNM was 50.64%(473/934); the rates of central and lateral LNM were 47.86%(447/934)and 20.77%(194/934), respectively. Among the 447 patients with central LNM, 168(37.58%)also had lateral LNM. The rate of lateral LNM without central LNM was 2.78%(26/934). Chi-square analysis showed that male, tumor diameter larger than 0.55 cm, extracapsular invasion, bilateral cancer, and multifocality were related to higher rate of cervical LNM, central LNM and lateral LNM(P<0.05); patients without Hashimotos thyroiditis had higher rate of cervical LNM and central LNM(P<0.05); patients of specific pathological types had higher rate of cervical LNM and lateral LNM(P<0.05). The binary multivariate Logistic regression analysis showed that male, tumor diameter larger than 0.55 cm, bilateral cancer, and without Hashimotos thyroiditis were independent risk factors of cervical LNM and central LNM; tumor diameter larger than 0.55 cm, extracapsular invasion, and specific pathological subtypes were independent risk factors of lateral LNM. For PTMC patients with single foci, the rate of lateral LNM was higher when the tumor was located in the upper pole of glands and isthmus than in the middle and lower. Conclusion PTMC patients with high probability of central LNM should receive regular central lymph node dissection. For patients with tumor diameter larger than 0.55cm, extracapsular invasion, specific pathological subtypes, and tumor located in the upper pole or isthmus, there is an increased risk of lateral LNM, and lateral lymph node dissection can be considered.

Key words: Papillary thyroid microcarcinoma, Cervical lymph node metastasis, Metastasis rate, Risk factors

中图分类号: 

  • R736.1
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