山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (6): 54-64.doi: 10.6040/j.issn.1671-7554.0.2024.0074
• 临床医学 • 上一篇
林雨洋,王蓓,李菲
LIN Yuyang, WANG Bei, LI Fei
摘要: 目的 预测直径>10 mm(非T1a期)甲状腺乳头状癌(papillary thyroid carcinoma, PTC)患者侧颈区淋巴结转移(lateral lymph node metastasis, LLNM),并分析其转移模式。 方法 回顾性分析166例行甲状腺切除术合并侧颈区清扫术且病灶直径>10 mm的PTC患者资料;分析其临床病理特征及侧颈部各分区淋巴结转移模式。收集临床病理、超声特征及实验室检查结果等资料,利用单因素、多因素Logistic回归分析来评估与LLNM相关因素;在此结果上建立列线图模型,采用受试者工作特征(receiver operating characteristic, ROC)曲线评估其模型的准确性。 结果 LLNM最常见于Ⅲ区(38.1%),且两个区域转移模式(42.2%)最常见。当病灶位于腺体不同位置时,淋巴结转移模式差异无统计学意义(P>0.05)。多因素Logistic回归结果显示,病灶位置、游离三碘甲腺原氨酸(free triiodothyronine, FT3)、促甲状腺激素(thyroid stimulating hormone, TSH)、甲状腺过氧化物酶抗体(thyroid peroxidase antibodies, TPOAB)水平及中央区淋巴结转移(central lymph node metastasis, CLNM)数目均是LLNM的独立危险因素。列线图预测模型的曲线下面积为0.851,提示模型诊断准确度较高。 结论 基于临床病理、超声特征及实验室结果(CLNM数目、病灶位置、FT3、TSH及TPOAB水平)的列线图模型对预测直径>10 mm PTC患者LLNM表现良好,可用于临床应用指导。
中图分类号:
[1] 刘燕,曹广磊,陈丽.超声引导下细针穿刺和BRAFV600E分子检测在甲状腺癌诊断中的价值[J].山东大学学报(医学版), 2022, 60(10): 57-61. LIU Yan, CAO Guanglei, CHEN Li. Ultrasound-guided fine needle aspiration biopsy and BRAFV600E molecular detection in the diagnosis of thyroid cancer[J]. Journal of Shandong University(Health Sciences), 2022, 60(10): 57-61. [2] Haugen BR, Alexander EK, Bible KC, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2016, 26(1): 1-133. [3] Heng Y, Feng S, Yang Z, et al. Features of lymph node metastasis and structural recurrence in papillary thyroid carcinoma located in the upper portion of the thyroid: a retrospective cohort study[J]. Front Endocrinol, 2022,12: 793997. doi:10.3389/fendo.2021.793997. [4] Feng JW, Ye J, Hong LZ, et al. Nomograms for the prediction of lateral lymph node metastasis in papillary thyroid carcinoma: Stratification by size[J]. Front Oncol, 2022,12: 944414. doi:10.3389/fonc.2022.944414. [5] Gao L, Li X, Xia Y, et al. Large-volume lateral lymph node metastasis predicts worse prognosis in papillary thyroid carcinoma patients with N1b[J]. Front Endocrinol,2022,12: 815207. doi:10.3389/fendo.2021.815207. [6] 张宏,钱林学.甲状腺乳头状癌超声特征预测侧颈区淋巴结转移的研究[J].中国医药生物技术, 2023, 18(4): 344-349. ZHANG Hong, QIAN Linxue, Predictive value of ultrasonographic features of papillary thyroid carcinoma nodules for lateral cervical lymph node metastasis[J]. Chinese Medicinal Biotechnology, 2023, 18(4): 344-349. [7] Song WJ, Um IC, Kwon SR, et al. Predictive factors of lymph node metastasis in papillary thyroid cancer[J]. PLoS One, 2023,18(11): e0294594. doi:10.1371/journal.pone.0294594. [8] 邵长秀,贺青卿,庄晓璇,等.934例甲状腺微小乳头状癌颈淋巴结部位转移及危险因素[J].山东大学学报(医学版), 2023, 61(2): 57-64. SHAO Changxiu, HE Qingqing, ZHUANG Xiaoxuan. Patterns and risk factors of cervical lymph node metastasis in 934 cases of papillary thyroid microcarcinoma[J]. Journal of Shandong University(Health Sciences), 2023, 61(2): 57-64. [9] Liu JJ, Liu LP, Zhang YJ, et al. Analysis of characteristics microvessel density of thyroid malignant and benign nodules on contrast-enhanced ultrasonography[J]. AUTD, 2018, 2(3): 167-172. [10] 徐震纲,刘绍严.分化型甲状腺癌颈侧区淋巴结清扫专家共识(2017版)[J].中国实用外科杂志, 2017, 37(9): 985-991. [11] Caliskan O, Unlu MT, Yanar C, et al. Predictive factors affecting the development of lateral lymph node metastasis in papillary thyroid cancer[J]. Sisli Etfal Hastan Tip Bul, 2023, 57(3): 312-319. [12] White C, Weinstein MC, Fingeret AL, et al. Is less more? a microsimulation model comparing cost-effectiveness of the revised American Thyroid Associations 2015 to 2009 guidelines for the management of patients with thyroid nodules and differentiated thyroid cancer[J]. Ann Surg, 2020, 271(4): 765-773. [13] Takami H, Ito Y, Okamoto T, et al. Therapeutic strategy for differentiated thyroid carcinoma in Japan based on a newly established guideline managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons[J]. World J Surg, 2011, 35(1): 111-121. [14] Lai SW, Fan YL, Zhu YH, et al. Machine learning-based dynamic prediction of lateral lymph node metastasis in patients with papillary thyroid cancer[J]. Front Endocrinol, 2022, 13: 1019037. doi: 10.3389/fendo.2022.1019037. [15] Arishi AA, Abualhana F, Sferra J. Horners syndrome following thyroid surgery[J]. Cureus, 2023,15(9): e45825. doi:10.7759/cureus.45825. [16] Kim SK, Park I, Hur N, et al. Patterns, predictive factors and prognostic impact of multilevel metastasis in N1b papillary thyroid carcinoma[J]. Br J Surg, 2017, 104(7): 857-867. [17] Feng Y, Min Y, Chen H, et al. Construction and validation of a nomogram for predicting cervical lymph node metastasis in classic papillary thyroid carcinoma[J]. J Endocrinol Invest, 2021, 44(10): 2203-2211. [18] Feng JW, Hong LZ, Wang F, et al. A nomogram based on clinical and ultrasound characteristics to predict central lymph node metastasis of papillary thyroid carcinoma[J]. Front Endocrinol, 2021,12: 666315. doi:10.3389/fendo.2021.666315. [19] So YK, Kim MJ, Kim S, et al. Lateral lymph node metastasis in papillary thyroid carcinoma: a systematic review and meta-analysis for prevalence, risk factors, and location[J]. Int J Surg, 2018, 50: 94-103. doi: 10.1016/j.ijsu.2017.12.029. [20] Liu XN, Duan YS, Yue K, et al. The optimal extent of lymph node dissection in N1b papillary thyroid microcarcinoma based on clinicopathological factors and preoperative ultrasonography[J]. Gland Surg, 2022,11(6): 1047-1056. [21] Gong J, Zhu B, Liu W, et al. Risk factors for lymph node metastasis in papillary thyroid carcinoma: a retrospective study[J]. Horm Metab Res, 2023, 55(5): 315-322. [22] Wang Y, Deng C, Shu X, et al. Risk factors and a prediction model of lateral lymph node metastasis in cN0 papillary thyroid carcinoma patients with 1-2 central lymph node metastases[J]. Front Endocrinol, 2021, 12: 716728. doi: 10.3389/fendo.2021.716728. [23] Dolidze DD, Shabunin AV, Mumladze RB, et al. A narrative review of preventive central lymph node dissection in patients with papillary thyroid cancer- A necessity or an excess[J]. Front Oncol, 2022,12: 906695. doi:10.3389/fonc.2022.906695. [24] Dou Y, Hu D, Chen Y, et al. PTC located in the upper pole is more prone to lateral lymph node metastasis and skip metastasis[J]. World J Surg Oncol, 2020, 18(1):188. doi:10.1186/s12957-020-01965-x. [25] 何小景,刘洋,刘华朋,等.血清甲状腺激素及抗体水平与分化型甲状腺癌风险等级的关系[J].临床医学, 2024, 44(1): 36-38. [26] Xu B, Gu SY, Zhou NM, et al. Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: a meta-analysis[J]. Open Life Sci, 2023, 18(1): 20220671. doi: 10.1515/biol-2022-0671. [27] Mao A, An N, Wang J, et al. Association between preoperative serum TSH and tumor status in patients with papillary thyroid microcarcinoma[J]. Endocrine, 2021, 73(3): 617-624. [27] Xiang Y, Xu Y, Bhandari A, et al. Serum TSH levels are associated with postoperative recurrence and lymph node metastasis of papillary thyroid carcinoma[J]. Am J Transl Res, 2021,13(6): 6108-6116. [29] Huang D, Zhi J, Zhang J, et al. Relationship between thyroid autoantibodies and recurrence of papillary thyroid carcinoma in children and adolescents[J]. Front Oncol, 2022, 12: 883591. doi: 10.3389/fonc.2022.883591. [30] Yang Y, Liu J, Shi X, et al. Clinical and pathological characteristics of patients with papillary thyroid carcinoma coexisting with Hashimotos Thyroiditis: a retrospective cohort study[J]. Cancer Control, 2023, 30: 10732748231199647. doi:10.1177/10732748231199647. [31] Huang K, Gao N, Bian D, et al. Associations of BRAFV600E, clinical pathology and imaging factors with the recurrence rate of papillary thyroid microcarcinoma[J]. Exp Ther Med, 2020, 20(6): 243. doi: 10.3892/etm.2020.9373. [32] Chang Q, Zhang J, Wang Y, et al. Nomogram model based on preoperative serum thyroglobulin and clinical characteristics of papillary thyroid carcinoma to predict cervical lymph node metastasis[J]. Front Endocrinol, 2022,13: 937049. doi: 10.3389/fendo.2022.937049. [33] Liu S, Liu C, Zhao L, et al. A prediction model incorporating the BRAFV600E protein status for determining the risk of cervical lateral lymph node metastasis in papillary thyroid cancer patients with central lymph node metastasis[J]. Eur J Surg Oncol, 2021, 47(11): 2774-2780. |
[1] | 刘馨,侯新国,刘继东,赵红霞. 伴TSHR基因突变促甲状腺激素抵抗综合征1例[J]. 山东大学学报 (医学版), 2023, 61(10): 113-116. |
[2] | 张薇薇,华芳,梁超帅,褚苗苗,孙嘉忆,Frank Zaucke,辛玮. 促甲状腺激素通过抗炎蛋白CTRP3促进软骨细胞分化[J]. 山东大学学报 (医学版), 2022, 60(10): 1-8. |
[3] | 王余余,高丽,陈少华. 94例2型糖尿病患者急性脑梗死后认知障碍与甲状腺功能的关联性[J]. 山东大学学报 (医学版), 2020, 58(5): 56-61. |
[4] | 石飞,潘翔,杨见明. 106例甲状腺乳头状癌患者行甲状腺全切手术后生存质量分析[J]. 山东大学学报 (医学版), 2020, 58(5): 87-92. |
[5] | 于娜,郭情情,孙梅,盛燕,马增香,秦莹莹. 甲状腺癌术后行IVF/ICSI-ET助孕临床结局[J]. 山东大学学报 (医学版), 2018, 56(9): 54-58. |
[6] | 张琳,李敬,王泽,张江涛,马增香,石玉华. 多囊卵巢综合征患者促甲状腺激素对血糖、血脂的影响[J]. 山东大学学报(医学版), 2017, 55(1): 80-84. |
[7] | 郝战宇,李波. 桥本甲状腺炎合并甲状腺乳头状癌的临床及病理学特征[J]. 山东大学学报(医学版), 2016, 54(6): 73-77. |
[8] | 申妍,左常婷. 济南地区正常妊娠妇女各期甲状腺功能指标的参考值范围评估[J]. 山东大学学报(医学版), 2016, 54(5): 34-38. |
[9] | 王琦1,2,于春晓3,高聆1,赵家军3,曹铭锋3. 1-7554.0.2013.611促甲状腺激素调节肝脏AMPKα Thr 172而非Ser 173的磷酸化[J]. 山东大学学报(医学版), 2014, 52(6): 22-27. |
[10] | 王付颖1,刘晓萌2,董庆玉2,梁翠格2,杜文华2,王月丽2,李文侠2,高冠起2. Graves病患者131I治疗后TRAb变化与早发甲减的相关性[J]. 山东大学学报(医学版), 2014, 52(6): 55-57. |
[11] | 张雯雯1,张艳玲1,王杰1,高聆2,于春晓1,阎慧丽1,徐进1. 促甲状腺激素对破骨细胞分化的影响[J]. 山东大学学报(医学版), 2013, 51(4): 6-10. |
[12] | 李亚男1,蒋玲1,胡秀慧1,张晓黎1,李杰2. 碘酸钾和双酚A对甲状腺乳头状癌细胞增殖的影响[J]. 山东大学学报(医学版), 2013, 51(3): 52-57. |
[13] | 李建周,刘欣,张凌云,金勇君. 术前血清TSH浓度与分化型甲状腺癌的相关性研究[J]. 山东大学学报(医学版), 2011, 49(1): 10-13. |
|