甲状腺乳头状癌患者甲状腺肿瘤特征对颈侧区淋巴结转移的影响

Effect of thyroid tumor characteristics on lateral lymph node metastasis in papillary thyroid carcinoma

摘要:

目的 研究甲状腺乳头状癌患者甲状腺肿瘤特征对颈侧区淋巴结转移的预测作用。方法 回顾性分析2017年1月—2020年12月手术治疗的甲状腺乳头状癌患者的临床资料509例，男105例，女404例;年龄18~85岁，平均(45.38±14.85)岁。其中临床分期Ⅰ期382例，Ⅱ期127例。采用多因素二元Logistic回归分析甲状腺乳头状癌患者颈侧区淋巴结转移的影响因素。结果 根据病理诊断结果是否存在颈侧区淋巴结转移，其中178例患者存在颈侧区淋巴结转移，331例患者不存在颈侧区淋巴结转移。存在颈侧区转移和不存在颈侧区转移的患者临床资料比较发现，存在颈侧区转移的患者中年龄<40岁、肿瘤最大直径>2 cm、转移中央区淋巴数量>5个、多灶性以及鼠类肉瘤滤过性毒菌致癌基因同源体B1(v-raf murine sarcoma viral oncogene homolog B1,BRAF)不存在突变的患者比例显著高于存在颈侧区转移的患者(P<0.05)。采用多因素二元Logistic回顾分析结果发现肿瘤最大直径>2 cm (OR=3.482，95%CI:1.482~5.642，P=0.000)、转移中央区淋巴结数量>5个(OR=6.583，95%CI:2.384~12.373，P=0.000)、多灶性(OR=3.473，95%CI:1.387~8.684，P=0.032)以及BRAF不存在突变(OR=3.952，95%CI:1.489~9.572，P=0.000)是甲状腺乳头状癌发生颈侧区淋巴结转移的独立危险因素。结论 肿瘤最大直径>2 cm、转移中央区淋巴数量>5个、多灶性以及BRAF不存在突变是甲状腺乳头状癌患者出现颈侧区淋巴结转移的独立危险因素。

关键词:甲状腺乳头状癌;肿瘤特征;颈侧区淋巴结转移;危险因素

Abstract:

Objective To investigate the predictive effect of thyroid tumor characteristics on lateral lymph node metastasis in patients with papillary thyroid carcinoma. Methods The clinical data of 509 patients with papillary thyroid carcinoma treated by surgery from Jan 2017 to Dec 2020 were retrospectively analyzed. All the patients included 105 males and 404 females, aged 18-85 years, with an average of (45.38±14.85) years. Among them, 382 cases were in clinical stage Ⅰ and 127 in stage Ⅱ. Multivariate binary logistic regression was used to analyze the influencing factors of cervical lateral lymph node metastasis in patients with papillary thyroid carcinoma. Results Pathological examination confirmed lateral lymph node metastasis in 178 of all the 509 cases. Comparisons of the data from patients with and without lateral lymph node metastasis revealed that the proportions of age younger than 40 years old, the largest tumor diameter >2 cm, the number of metastatic lymph nodes in the central region >5, multifocality and no BRAF(v-raf murine sarcoma viral oncogene homolog B1)mutation in the patients with metastasis were significantly higher than those without metastasis (P<0.05). The results of multivariate binary logistic retrospective analysis showed that the maximum tumor diameter >2 cm (P=0.000, OR=3.482, 95%CI:1.482-5.642), the number of metastatic lymph nodes in the central region >5 (P=0.000, OR=6.583, 95%CI:2.384-12.373), multifocality (P=0.032, OR=3.473, 95%CI:1.387-8.684), and the negative of BRAF mutation (P=0.000, OR=3.952, 95%CI:1.489-9.572) were independent risk factors for lateral lymph node metastasis in papillary thyroid carcinoma. Conclusion The maximum tumor diameter >2 cm, the number of metastatic lymph nodes in the central region >5, multifocality and the negative of BRAF mutation were independent risk factors for cervical lymph node metastasis in patients with papillary thyroid carcinoma.

Key words:Papillary thyroid carcinoma;Tumor characteristic;Lateral lymph node metastasis;Risk factor