多灶性甲状腺乳头状癌的临床病理及颈淋巴结转移特征

目的:探讨多灶性甲状腺乳头状癌(PTC)的临床病理及颈淋巴结转移特征。方法:回顾性分析2016年6月—2016年10月于郑州大学第一附属医院甲状腺外科行手术治疗并经术后病理证实的323例PTC患者的临床资料,其中多灶性PTC患者148例,单灶性PTC患者175例。结果:多灶性PTC患者与单灶性PTC患者间性别、年龄、癌灶最大径差异无统计学意义(均P0.05),但前者更易发生颈部中央区淋巴结转移(P0.001)、颈侧区淋巴结转移(P=0.028)及腺外浸润(P0.001);多灶性PTC患者中,癌灶数≥3的患者中央区淋巴结转移率(P=0.010)、侧区淋巴结转移率(P=0.018)及腺外浸润的发生率(P=0.020)明显高于癌灶数=2的患者;多因素分析显示,癌灶最大径(P=0.005)及癌灶数量(P=0.006)为多灶性PTC中央区淋巴结转移的独立危险因素。结论:多灶性PTC较单灶性PTC侵袭性强,更易发生转移、浸润,建议选择全甲状腺切除加中央区淋巴结清扫作为标准化手术方式,颈侧区存在可疑肿大淋巴结者应积极行颈侧区淋巴结清扫术。

Clinicopathologic and neck metastasis features of multifocal papillary thyroid cancer

Objective: To investigate the clinicopathologic and neck metastasis features of multifocal papillary thyroid cancer (PTC). Methods: The clinical data of 323 patients undergoing surgical treatment in Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University from June 2016 to October 2016, who had pathologically confirmed PTC were retrospectively analyzed. Of the patients, 148 cases had multifocal PTC and 175 cases were unifocal PTC. Results: No significant difference was seen in age, gender and maximal tumor diameter between patients with multifocal PTC and unifocal PTC (all P>0.05), but the former showed higher incidence of central neck metastasis (P<0.001), lateral neck metastasis (P=0.028), and extrathyroidal extension (P<0.001) than those in the latter. Among patients with multifocal PTC, the incidence of central neck metastasis (P=0.010), lateral neck metastasis (P=0.018) and extrathyroidal extension (P=0.020) in cases with 3 or more lesions were significantly increased compared with cases with 2 lesions. Multivariate analysis showed that the maximal tumor diameter (P=0.005) and tumor number (P=0.006) were independent risk factors for central neck metastasis in multifocal PTC. Conclusion: Compared to unifocal PTC, multifocal PTC has relatively higher invasiveness, is more likely to develop metastasis and invasion, for which total thyroidectomy with central compartment neck dissection is recommended as the standard treatment, and lateral neck dissection should be strongly considered in those with lateral neck lymph node enlargement.