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浙江大学学报(医学版)  2022, Vol. 51 Issue (2): 225-232    DOI: 10.3724/zdxbyxb-2021-0389
原著     
多灶性甲状腺乳头状癌患者临床特征及发生颈部转移性淋巴结的危险因素
倪雅琼,王涛(),王兴越,田尤新,魏温涛,刘勤江
甘肃省肿瘤医院头颈外科,甘肃 兰州 730050
Clinical features of multifocal papillary thyroid carcinoma and risk factors of cervical metastatic lymph nodes
NI Yaqiong,WANG Tao(),WANG Xingyue,TIAN Youxin,WEI Wentao,LIU Qinjiang
Department of Head and Neck Surgery, Gansu Provincial Cancer Hospital, Lanzhou 730050, China
 全文: PDF(2273 KB)   HTML( 8 )
摘要:

目的:分析多灶性甲状腺乳头状癌(PTC)患者的临床特征及发生颈部转移性淋巴结的危险因素。方法:收集2020年1月至2021年8月在甘肃省肿瘤医院经手术后病理学检查确诊的PTC患者1524例,其中多灶性PTC 492例,单灶性PTC 1032例。通过比较多灶性与单灶性PTC患者在性别、民族、年龄、身体质量指数、合并糖尿病、合并高血压、术前促甲状腺激素及甲状腺球蛋白(TG)水平、病灶范围、病灶最大径、病灶直径总和、颈部中央区和颈侧区转移性淋巴结、是否合并桥本甲状腺炎以及甲状腺癌侵犯被膜等方面的差异,分析多灶性PTC的临床病理学特征。同时,根据是否出现中央区转移性淋巴结和颈侧区转移性淋巴结将患者进行分组,比较患者上述临床病理指标的差异,并采用多因素logistic回归分析危险因素。结果:与单灶性PTC患者比较,多灶性PTC患者中55岁以上、合并高血压、出现中央区或颈侧区转移性淋巴结、合并桥本甲状腺炎及甲状腺癌侵犯被膜患者的比例更高(均P<0.05);55.1%多灶性PTC患者的病灶分布在双侧腺体,且病灶最大径和病灶直径总和均大于单灶性PTC患者(均P<0.01)。多因素logistic回归分析结果显示,男性、病灶最大径超过7?mm、甲状腺癌侵犯被膜是多灶性PTC患者发生中央区转移性淋巴结的危险因素(均P<0.05);男性、病灶最大径超过7?mm、术前TG超过55?ng/mL、中央区转移性淋巴结是多灶性PTC患者发生颈侧区转移性淋巴结的危险因素(均P<0.05)。结论:多灶性PTC患者出现中央区及颈侧区转移性淋巴结的比例均高于单灶性PTC,且当患者为男性、病灶最大径超过7?mm、甲状腺癌侵犯被膜、术前TG超过55?ng/mL时发生转移性淋巴结的风险较高。

关键词: 甲状腺乳头状癌多灶性临床特征转移性淋巴结危险因素    
Abstract:

Objective: To analyze the clinical features of multifocal papillary thyroid carcinoma (PTC) and the risk factors of cervical metastatic lymph nodes. Methods: A total of 1524 patients with papillary thyroid carcinoma admitted in Gansu Provincial Cancer Hospital from January 2020 to August 2021 were enrolled, including 492 cases of multifocal PTC and 1032 cases of unifocal PTC. The clinicopathologic features of multifocal PTC and unifocal PTC were analyzed by comparing their differences in gender, ethnicity, age, body mass index, accompanying diabetes mellitus, accompanying hypertension, preoperative thyroid stimulating hormone and thyroglobulin levels, location of lesions, maximum diameter of lesions, sum of lesion diameters, central metastatic lymph nodes, lateral cervical metastatic lymph nodes, presence of Hashimoto’s thyroiditis, and thyroid capsule invasion. Patients were also assessed according to the presence or absence of central metastatic lymph nodes and lateral cervical metastatic lymph nodes to understand clinicopathological parameter differences, and multivariate logistic regression analysis was used to explore the risk factors. Results: Compared with unifocal PTC group, multifocal PTC group had significantly higher proportion of patients aged over 55?years, accompanying hypertension, central metastatic lymph nodes or cervical metastatic lymph nodes, Hashimoto’s thyroiditis and capsule invasion (all P<0.05); 55.1% of patients with multifocal PTC had lesions distributed bilaterally, and the maximum diameter and diameter sum of the lesions were greater than those in unifocal PTC group (allP<0.01). Multivariate logistic regression analysis showed that male, maximum diameter of lesion more than 7?mm, capsular invasion were independent risk factors for central metastatic lymph nodes (allP<0.05); while male, maximum diameter of lesion more than 7?mm, preoperative thyroglobulin more than 55?ng/mL, and central metastatic lymph nodes were risk factors for lateral cervical metastatic lymph nodes in patients with multifocal PTC (allP<0.05).Conclusion: Patients with multifocal PTC have significantly higher central and lateral cervical metastatic lymph nodes, particularly for male patients with a maximum diameter of lesion more than 7?mm, invasion of capsule, and preoperative thyroglobulin more than 55?ng/mL.

Key words: Papillary thyroid carcinoma    Multifocal    Clinical features    Metastatic lymph node    Risk factor
收稿日期: 2021-12-15 出版日期: 2022-08-02
CLC:  R736.1  
基金资助: 甘肃省自然科学基金(20JR10RA362)
通讯作者: 王涛     E-mail: ao
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引用本文:

倪雅琼,王涛,王兴越,田尤新,魏温涛,刘勤江. 多灶性甲状腺乳头状癌患者临床特征及发生颈部转移性淋巴结的危险因素[J]. 浙江大学学报(医学版), 2022, 51(2): 225-232.

NI Yaqiong,WANG Tao,WANG Xingyue,TIAN Youxin,WEI Wentao,LIU Qinjiang. Clinical features of multifocal papillary thyroid carcinoma and risk factors of cervical metastatic lymph nodes. J Zhejiang Univ (Med Sci), 2022, 51(2): 225-232.

链接本文:

https://www.zjujournals.com/med/CN/10.3724/zdxbyxb-2021-0389        https://www.zjujournals.com/med/CN/Y2022/V51/I2/225

组别

n

男性

汉族

55岁以上

身体质量指数(kg/m2

合并糖尿病

合并高血压

术前TSH(mU/L)

术前TG超过55 ng/mL

单灶性PTC组

1032

228(22.1)

973(94.3)

160(15.5)

23.8±3.4

58(5.6)

100(9.7)

3.2(2.0,4.2)

134(13.0)

多灶性PTC组

492

105(21.3)

473(96.1)

102(20.7)

24.0±3.3

18(3.7)

66(13.4)

3.1(1.9,4.2)

80(16.3)

χ2/t/Z

0.110

2.362

6.396

–1.20

2.706

4.762

–0.654

2.962

P

>0.05

>0.05

<0.05

>0.05

>0.05

<0.05

>0.05

>0.05

组别

n

双侧病灶

病灶最大径(mm)

病灶直径总和(mm)

中央区转移性淋巴结

颈侧区转移性淋巴结

合并桥本甲状腺炎

甲状腺癌侵犯被膜

单灶性PTC组

1032

0(0.0)

6(4,9)

6(4,9)

301(29.2)

76(7.4)

301(29.2)

693(67.2)

?

多灶性PTC组

492

271(55.1)

7(5,10)

14(9,19)

176(35.8)

59(12.0)

172(35.0)

396(80.5)

χ2/t/Z

691.382

5.061

19.954

6.761

8.837

5.223

29.054

?

P

<0.01

<0.01

<0.01

<0.01

<0.01

<0.05

<0.01

?
表 1  多灶性与单灶性PTC患者临床病理学特征比较

组 别

n

男性

汉族

55岁以上

身体质量指数(kg/m2

合并糖尿病

合并高血压

术前TSH(mU/L)

术前TG超过55 ng/mL

无转移组

316

52(16.5)

303(95.9)

70(22.2)

24.2± 3.2

13(4.1)

43(13.6)

3.1(1.9,4.5)

46(14.6)

转移组

176

53(30.1)

170(96.6)

32(18.2)

23.7± 3.6

5(2.8)

23(13.1)

3.1(1.9,4.1)

34(19.3)

χ2/t/Z

12.561

0.151

1.084

1.39

0.520

0.028

–0.978

1.882

P

<0.01

>0.05

>0.05

>0.05

>0.05

>0.05

>0.05

>0.05

组 别

n

双侧病灶

病灶最大径(mm)

病灶直径总和(mm)

病灶数3个及以上

颈侧区转移性淋巴结

合并桥本甲状腺炎

甲状腺癌侵犯被膜

无转移组

316

157(49.7)

7(5,9)

12(8,17)

111(35.1)

9(2.9)

111(35.1)

242(76.6)

?

转移组

176

114(64.8)

9(7,13)

16(11,24)

80(45.5)

50(28.4)

61(34.7)

154(87.5)

χ2/t/Z

10.402

6.599

6.442

5.077

69.981

0.011

8.580

?

P

<0.01

<0.01

<0.01

<0.05

<0.01

>0.05

<0.01

?
表 2  是否发生中央区转移性淋巴结的多灶性PTC患者临床病理学特征比较

变量

OR

95%CI

P

男性

2.317

1.465~3.663

<0.01

病灶最大径超过7?mm

2.245

1.502~3.356

<0.01

病灶数3个及以上

1.222

0.784~1.907

>0.05

甲状腺癌侵犯被膜

1.853

1.067~3.219

<0.05

双侧病灶

1.503

0.961~2.352

>0.05

表 3  多灶性PTC患者发生中央区转移性淋巴结的多因素分析结果

组别

n

男性

汉族

55岁以上

身体质量指数(kg/m2

合并糖尿病

合并高血压

术前TSH(mU/L)

术前TG超过55 ng/mL

未转移组

433

82(18.9)

415(95.8)

92(21.3)

24.1 ±3.4

17(3.9)

63(14.6)

3.1 (1.9,4.3)

58(13.4)

转移组

59

23(39.0)

58(98.3)

10(17.0)

23.2 ±3.2

1(1.7)

3(5.1)

3.1(2.1,4.2)

22(37.3)

χ2/t/Z

12.429

0.584

1.95

4.005

–0.174

21.770

P

<0.01

>0.05

>0.05

>0.05

>0.05

<0.05

>0.05

<0.01

组别

n

双侧病灶

病灶最大径(mm)

病灶直径总和(mm)

病灶数3个及以上

中央区转移性淋巴结

合并桥本甲状腺炎

甲状腺癌侵犯被膜

未转移组

433

232(53.6)

7(5,10)

13(8,18)

160(37.0)

126(29.1)

150 (34.6)

347(80.1)

?

转移组

59

39(66.1)

13(8,18)

21(16,31)

31(52.5)

50(87.5)

22(37.3)

49(83.1)

χ2/t/Z

3.291

6.973

6.515

5.314

69.981

0.160

0.280

?

P

>0.05

<0.01

<0.01

<0.05

<0.01

>0.05

>0.05

?
表 4  是否发生颈侧区转移性淋巴结的多灶性PTC患者临床病理学特征比较

变量

OR

95%CI

P

男性

2.619

1.316~5.212

<0.01

合并高血压

0.254

0.070~0.951

>0.05

术前TG超过55?ng/mL

3.277

1.561~6.673

<0.01

病灶最大径超过7?mm

3.135

1.536~6.400

<0.01

病灶数3个及以上

1.516

0.797~2.883

>0.05

中央区转移性淋巴结

10.751

4.951~23.342

<0.01

表 5  多灶性PTC患者发生颈侧区转移性淋巴结的多因素分析结果
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