cN0期甲状腺乳头状癌中央区淋巴结转移的危险因素分析

 目的 探讨cN0期甲状腺乳头状癌患者中央区淋巴结转移相关危险因素。方法 纳入北京协和医院行双侧中央区淋巴结清扫的cN0期甲状腺乳头状癌患者570例,回顾性分析患者术前甲状腺超声图像及临床病理资料特征,分析预测cN0期甲状腺乳头状癌中央区淋巴结转移相关危险因素。结果 570例cN0期甲状腺乳头状癌患者中发生中央区淋巴结转移282例,占49.5%;其中男性(OR=1.787, 95% CI:1.066-2.997, P=0.028)、年龄小于45岁(OR=2.063, 95% CI:1.366-3.115, P=0.001)、多发病灶(OR=1.764, 95% CI:1.134-2.743, P=0.012)、肿瘤直径＞1 cm(OR=1.844, 95% CI:1.201-2.831, P=0.005)、伴有微钙化(OR=1.965, 95% CI:1.296-2.979, P=0.001)且有被膜侵犯(OR=2.868, 95% CI:1.880-4.377, P=0.000)是中央区淋巴结转移的独立危险因素。结论 对于男性、年龄小于45岁、多发病灶、肿瘤直径＞1 cm、伴有微钙化且有被膜侵犯的cN0期甲状腺乳头状癌应根据影像学及临床病理资料考虑采取积极的手术方式或更加密切的随访。

Prediction of central lymph node metastasis in cN0 stage papillary thyroid carcinoma

Objective To analyze the risk factors of central lymph node(CLN) metastasis in patients with cN0 stage papillary thyroid carcinoma(PTC).Methods: We retrospectively studied 570 patients with cN0 stage PTC who underwent bilateral CLN dissection in Peking Union Medical College Hospital from 2013 to 2015. CLN metastasis was identified by histopathology. Patients with different CLN metastasis statuses were compared according to clinical, sonographic and pathological parameters.Results The prevalence of CLN metastasis was 49.5% in cN0 patients with PTC. CLN metatasis was independent associated with Male(OR=1.787, 95% CI:1.066-2.997, P=0.028), <45 years old(OR=2.063, 95% CI:1.366-3.115, P=0.001), multifocal lesions (OR=1.764, 95% CI:1.134-2.743, P=0.012), tumor diameter(OR=1.844, 95% CI:1.201-2.831, P=0.005) >1 cm, microcalcification(OR=1.965, 95%,CI:1.296-2.979, P=0.001) and capsular invasion (OR=2.868, 95% CI:1.880-4.377, P=0.000) were independent risk factors.Conclusions The CLNM rates of PTC cN0 patients with the six factors (Male, <45 years old, multifocal lesions, tumor diameter>1 cm, microcalcification and capsular invasion) were relatively higher than those without. These findings may be useful for identifying patients at higher central lymph node metastasis risk, who may require more aggressive treatment or intensive follow-up management.