目的 研究分化型甲状腺癌（DTC）术后首次131I治疗前颈部淋巴结转移（CLNM）的危险因素。 方法 回顾性分析2020年1月至2022年7月于空军军医大学第二附属医院行全甲状腺切除术（TT）及首次131I治疗的332例DTC患者的临床资料，参考首次131I治疗后全身显像（Rx-WBS）+SPECT/CT断层融合显像诊断结果，结合临床表现、其它影像资料和生化指标综合评估，将患者分颈部淋巴结转移阳性组（CLNM+）和阴性组（CLNM-）。采用χ2检验、Mann-Whitney U检验比较两组间临床病理特征的差异；采用二分类Logistic回归分析CLNM的危险因素。 结果 332例DTC患者中，CLNM-组239例，CLNM+组93例，CLNM-组和CLNM+组间性别、原发灶数目、原发灶最大径、被膜侵犯、病理N分期（pN分期）、淋巴结清扫范围、转移淋巴结数目和刺激性甲状腺球蛋白（ps-Tg）差异有统计学意义（P<0.05）；年龄、TSH和中性粒细胞/淋巴细胞（N/L）值差异无统计学意义（均P>0.05）。单因素分析显示性别、原发灶数目、原发灶最大径、被膜侵犯、淋巴结清扫范围、pN分期、转移淋巴结数目、ps-Tg是DTC术后首次131I治疗前CLNM的显著影响因素（OR：2.16、87.04、1.21、2.16、1.92、1.55、1.04、1.02，均P<0.05）；多因素分析显示原发灶数目、被膜侵犯、淋巴结清扫范围、转移淋巴结数目和ps-Tg是CLNM的独立预测因素（均P<0.05）。 结论 CLNM更容易发生在具有多发病灶、被膜侵犯、中央区+颈侧区淋巴结清扫、转移淋巴结数目>6、ps-Tg水平偏高特征的DTC患者中，故需加强此类患者的临床管理。 Objective To analyze the risk factors of cervical lymph node metastasis (CLNM) before initial postoperative radioactive 131I therapy for differentiated thyroid cancer (DTC) . Methods The clinical data of 332 DTC patients who underwent total thyroidectomy (TT) and initial 131I treatment in Second Hospital Affiliated to Air Force Military Medical University from January 2020 to July 2022 were retrospectively analyzed. Based on the diagnosis results of the 131 I whole body imaging (Rx-WBS) +SPECT/CT fusion tomography, combined with the comprehensive evaluation of clinical manifestations, other image data and biochemical indicators, patients were divided into the positive group (CLNM+) and the negative group (CLNM-) . Chi-square (χ2) test or Mann-Whitney U test were used to analyze whether there were differences in various indicators between the two groups. The risk factors of CLNM were analyzed by binary logistic regression. Results Among 332 DTC patients, 239 cases were in the CLNM-group and 93 cases were in the CLNM+group. The difference of gender, number of primary tumor, maximum diameter of primary tumor, capsule invasion, pN stage, scope of lymph nodes dissection, number of metastasis lymph nodes and preablative stimulating thyroglobulin (ps-Tg) between the two groups was statistically significant (all P<0.05) , while the difference of age, TSH and neutrophil/lymphocytes (N/L) values was not statistically significant (allP>0.05) . Univariate analysis showed that gender, number of primary tumor, maximum diameter of primary tumor, capsule invasion, scope of lymph nodes dissection, pN stage, number of metastasis lymph nodes and ps-Tg were risk factors for CLNM (OR: 2.16, 87.04, 1.21, 2.16, 1.92, 1.55, 1.04 and 1.02, all P<0.05) . Multivariate analysis showed that number of primary tumor, capsule invasion, scope of lymph nodes dissection, number of metastasis lymph nodes and ps-Tg were independent predictors of CLNM (allP<0.05) . Conclusion CLNM is more likely to occur in DTC patients with multiple lesions, capsule invasion, more than 6 metastatic lymph nodes, central and lateral cervical lymph node dissection and higher ps-Tg level. For patients with the above characteristics, clinical management should be strengthened.
Abstract
Objective To analyze the risk factors of cervical lymph node metastasis (CLNM) before initial postoperative radioactive 131I therapy for differentiated thyroid cancer (DTC) . Methods The clinical data of 332 DTC patients who underwent total thyroidectomy (TT) and initial 131I treatment in Second Hospital Affiliated to Air Force Military Medical University from January 2020 to July 2022 were retrospectively analyzed. Based on the diagnosis results of the 131 I whole body imaging (Rx-WBS) +SPECT/CT fusion tomography, combined with the comprehensive evaluation of clinical manifestations, other image data and biochemical indicators, patients were divided into the positive group (CLNM+) and the negative group (CLNM-) . Chi-square (χ2) test or Mann-Whitney U test were used to analyze whether there were differences in various indicators between the two groups. The risk factors of CLNM were analyzed by binary logistic regression. Results Among 332 DTC patients, 239 cases were in the CLNM-group and 93 cases were in the CLNM+group. The difference of gender, number of primary tumor, maximum diameter of primary tumor, capsule invasion, pN stage, scope of lymph nodes dissection, number of metastasis lymph nodes and preablative stimulating thyroglobulin (ps-Tg) between the two groups was statistically significant (all P<0.05) , while the difference of age, TSH and neutrophil/lymphocytes (N/L) values was not statistically significant (allP>0.05) . Univariate analysis showed that gender, number of primary tumor, maximum diameter of primary tumor, capsule invasion, scope of lymph nodes dissection, pN stage, number of metastasis lymph nodes and ps-Tg were risk factors for CLNM (OR: 2.16, 87.04, 1.21, 2.16, 1.92, 1.55, 1.04 and 1.02, all P<0.05) . Multivariate analysis showed that number of primary tumor, capsule invasion, scope of lymph nodes dissection, number of metastasis lymph nodes and ps-Tg were independent predictors of CLNM (allP<0.05) . Conclusion CLNM is more likely to occur in DTC patients with multiple lesions, capsule invasion, more than 6 metastatic lymph nodes, central and lateral cervical lymph node dissection and higher ps-Tg level. For patients with the above characteristics, clinical management should be strengthened.
关键词
分化型甲状腺癌/颈部淋巴结转移/碘-131治疗/治疗剂量/131I全身显像/危险因素
Key words
Differentiated thyroid cancer/Cervical lymph node metastasis/Radioiodine-131 therapy/Rx-whole body scan/Risk factor
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