直径1 cm以上甲状腺乳头状癌侧颈淋巴结转移155例临床分析
Clinical analysis of papillary thyroid carcinoma(diameter＞1 cm)with lateral cervical lymph node metastasis in 155 cases
王艺微 1王圣应1
作者信息
- 1. 安徽省肿瘤医院头颈乳腺外科,合肥 230001
- 折叠
摘要
目的 分析原发灶直径1 cm以上甲状腺乳头状癌(papillary thyroid carcinoma,PTC)侧颈淋巴结转移(lateral cervical lymph node metastasis,LLNM)规律及相关影响因素,指导临床诊疗.方法 回顾性分析2022年1月至2022年12月安徽省肿瘤医院头颈乳腺外科155例行根治性手术治疗原发灶＞1 cm并伴LLNM的PTC患者临床病理资料,观察指标:性别、年龄、术式、原发灶数目、最大径、位置、合并桥本氏甲状腺炎(Hashimoto's thyroiditis,HT)、中央区及侧颈区淋巴结清扫总数及阳性数、转移比例及转移率.计量资料采用t检验,计数资料采用x2检验,以Pearson相关性分析及多因素回归分析淋巴结转移(lymph node me-tastasis,LNM)的影响因素.结果 155例PTC最大径(19.67±8.15)mm,共清扫中央区淋巴结1 933枚,转移比例91.61％(142/155),转移率50.77％±29.14％;共清扫侧颈淋巴结5 371枚,转移率14.44％±9.89％.Ⅲ区、Ⅳ区LNM发生比例分别为70.97％、60.10％,阳性率分别为19.51％、17.07％.43例发生侧颈单区转移,其中23例为单区寡转移.中央区淋巴结转移(central lymph node metastasis,CLNM)率与LLNM率呈正相关关系(Pearson=0.28,P=0.000).性别(P=0.022)、年龄(P=0.038)、病灶数(P=0.025)、病灶最大径(P=0.002)、有 HT(P=0.000)是CLNM率的独立影响因素.LLNM率仅与病灶最大径有关(P=0.040).侧颈单区转移仅与有无HT相关(P=0.034);有HT(OR=3.515,P=0.008)、单病灶(OR=3.217,P=0.047)是发生单区寡转移的独立影响因素.结论 在直径＞1cm的PTC病例,LLNM以Ⅲ区、Ⅳ区为转移最高发、最早发区域;LLNM率与CLNM率呈正相关.侧颈单区转移易在有HT患者中发生,当病灶为单灶时,更易出现单区寡转移,对此类患者应重视术前精准评估.
Abstract
Objective To analyze the regularity and related influencing factors of lateral cervical lymph node metastasis(LLNM)in papillary thyroid carcinoma(PTC)with primary lesion＞1 cm,and to guide clinical di-agnosis and treatment.Methods The clinicopathological data of 155 PTC patients with primary lesion＞1 cm and LLNM who underwent radical surgery in Anhui Cancer Hospital from Jan.2022 to Dec.2022 were retrospectively analyzed.The observation indicators were as follows:gender,age,operation method,number of primary lesions,maximum diameter,location,Hashimoto's thyroiditis(HT),total number and positive number of lymph nodes in central and lateral cervical regions,proportion and rate of metastasis.The measurement data were analyzed by t test,and the count data were analyzed byx2test.Pearson correlation analysis and multivariate regression analysis were used to evaluate the influencing factors of lymph node metastasis.Results The maximum diameter of PTC in 155 cases was(19.67±8.15)mm.A total of 1933 central lymph nodes were dissected,with metastasis ratio of 91.61％and average metastasis rate of 50.77％±29.14％.A total of 5371 lateral lymph nodes were dissected,with an average metastasis rate of 14.44％±9.89％.The proportion of LLNM in level Ⅲ and level Ⅳ was 70.97％and 60.10％respectively,and the positive rate was 19.51％and 17.07％respectively.43 cases were single-level LLNM,including 23 cases of single-level oligometastasis.There was a positive correlation between central lymph node me-tastasis(CLNM)rate and LLNM rate(Pearson=0.28,P=0.000).Gender(P=0.022),age(P=0.038),number of le-sions(P=0.025),maximum diameter of lesions(P=0.002),and HT(P=0.000)were independent factors of CLNM rate.Among the factors influencing the LLNM rate,only the maximum diameter of lesion showed statistical signifi-cance(P=0.040).Single-level LLNM was only associated with HT(P=0.034).HT(OR=3.515,P=0.008)and sin-gle lesion(OR=3.217,P=0.047)were independent factors for single-level oligometastasis.Conclusions In PTC cases with primary lesion＞1 cm,LLNM rate is positively correlated with that of CLNM.LLNM occurres most fre-quently in level Ⅲ and level Ⅳ.Single-level LLNM is more likely to occur in patients with HT,and when there's a single focus,single-level oligometastasis is more likely to occur.Accurate preoperative evaluation should be empha-sized for such patients.
关键词
甲状腺乳头状癌/侧颈淋巴结转移/单区转移Key words
Papillary thyroid carcinoma/Lateral cervical lymph node metastasis/Single-level metastasis引用本文复制引用
出版年
2024
NETL
NSTL
万方数据