Clinicopathological characteristics and cervical lymph node metastasis of multifocal papillary thyroid carcinoma
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摘要:
目的探讨多灶性甲状腺乳头状癌（MPTC）的临床病理特点及颈部淋巴结转移规律分析，为多灶性甲状腺癌的治疗提供依据。 方法回顾性分析2012~2016年788例于蚌埠医学院第一附属医院肿瘤外科行手术治疗且术后病理证实为多灶性甲状腺乳头状癌患者的临床资料。 结果纳入的788例MPTC患者，年龄8~81岁（46.28±12.49岁），其中男性138例（17.51%），年龄43.58±13.62岁；女性650例（82.49%），年龄46.86±12.17岁。≤45岁的287例（36.4%），>45岁的501例（63.6%）。双侧多灶患者495例（62.8%），单侧多灶293例（37.2%）。肿瘤直径>1 cm 377例（47.8%），肿瘤直径≤1 cm 411例（52.2%）。病灶数为2个的524例（66.5%），病灶数≥3个的264例（33.5%）。双侧多灶组合并桥本甲状腺炎、肿瘤直径>1 cm发生率明显高于单侧多灶组（P<0.01）。双侧多灶、包膜侵犯更倾向于发生颈部淋巴结转移，尤其是中央区淋巴结转移（P<0.01）。多灶组中随着癌灶数的增加，中央区及侧区淋巴结转移率明显增加（P<0 01="">1 cm发生淋巴转移的风险约是≤1 cm的3.805倍（P<0.01）；病灶数≥3个发生淋巴转移的风险是≤2的9.848倍。 结论男性、肿瘤最大径>1 cm及合并桥本氏甲状腺炎的患者易发生双侧多灶性甲状腺癌，且随着癌灶数量的增加，双侧多灶性甲状腺癌的比例明显增高。男性、年龄≤45岁、肿瘤直径>1 cm、双侧多灶，包膜侵犯更倾向于发生颈部淋巴结转移，随着癌灶数的增加，中央区及侧区淋巴结转移率明显增加。性别、病灶数量、大小、双侧分布均为淋巴结转移的独立危险因素。 Abstract:ObjectiveTo investigate the clinicopathological characteristics of multifocal papillary thyroid carcinoma (MPTC) and the regularity of cervical lymph node metastasis, and provide evidence for the treatment of multifocal thyroid cancer. MethodsThe clinical data of 788 patients with multifocal papillary thyroid cancer who underwent surgery in the First Affiliated Hospital of Bengbu Medical College from 2012 to 2016 were analyzed retrospectively. ResultsA total of 788 MPTC patients were enrolled. The overall age distribution was 8-81 years old, with an average age of 46.28±12.49 years. There were 138 males (17.51%) and 650 females (82.49%) with an average age of 43.58±13.62 and 46.86±12.17. In addition, 287 cases (36.4%) were younger than 45 years old and 501 cases (63.6%) were younger than 45 years old. 495 patients (62.8%) had bilateral multifocal lesions and 293 patients (37.2%) had unilateral multifocal lesions. 377 cases (47.8%) with diameter >1 cm and 411 cases (52.2%) with diameter <1 cm. There were 524 cases (66.5%) with 2 lesions and 264 cases (33.5%) with more than 3 lesions. The incidence of Hashimoto's thyroiditis and tumor diameter >1 cm in bilateral multifocal group was significantly higher than that in unilateral multifocal group (P<0.01). Bilateral multiple lesions and capsular invasion were more prone to cervical lymph node metastasis, especially central lymph node metastasis (P<0.01). The lymph node metastasis rate in the central and lateral regions increased significantly with the increase of the number of cancer foci in the multifocal group (P<0.01). The risk of lymphatic metastasis in lesions larger than 1 cm was 3.805 times higher than that in lesions less than 1 cm (P<0.01). The risk of lymphatic metastasis in lesions larger than 3 was 9.848 times higher than that in lesions less than 2. ConclusionMales, patients with tumor maximum diameter >1 cm and Hashimoto's thyroiditis are prone to bilateral multifocal thyroid cancer. The proportion of bilateral multifocal thyroid cancer increases significantly with the increase of the number of cancer foci. Male, age <45 years="" old="" tumor="" diameter="">1 cm, bilateral multiple lesions, capsular invasion is more likely to occur cervical lymph node metastasis, with the increase of the number of cancer lesions, central and lateral lymph node metastasis rate increased significantly. Gender, number, size and bilateral distribution of lesions are independent risk factors for lymph node metastasis. -
Key words:
- thyroid cancer /
- multiple lesions /
- cervical lymph nodes
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表 1 双侧多灶性PTC与单侧多灶性PTC临床病理资料比较（n）
因素 单侧多灶 双侧多灶 χ2 P 年龄（岁） ≤ 45 107 180 0.02 >0.05 ＞45 186 319 性别 男 65 73 7.05 <0.01 女 228 422 肿瘤直径（cm） ≤ 1 172 239 8.01 <0.01 ＞1 121 256 病灶数量（个） 2 215 297 12.70 <0.01 ≥3 78 198 合并桥本氏甲状腺炎 是 31 87 7.07 <0.01 否 262 408 
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表 2 颈部淋巴结转移相关病理因素分析
因素 中央区淋巴结 χ2 P 颈侧区淋巴结 χ2 P 阳性 阴性 阳性 阴性 性别 男 98 40 25.12 <0.01 54 84 9.93 <0.01 女 309 341 168 482 年龄（岁） ≤ 45 172 172 12.39 <0.01 92 195 6.75 <0.01 ＞45 235 266 118 383 肿瘤最大径（cm） ≤ 1 191 220 9.92 <0.01 78 333 19.97 <0.01 ＞1 216 161 124 253 病灶分布 单侧多灶 109 184 38.99 <0.01 55 238 6.64 <0.01 双侧多灶 298 197 133 362 侵犯包膜 是 69 28 16.82 <0.01 42 55 18.11 <0.01 否 338 353 160 531
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表 3 病灶数量与颈部淋巴结转移相关性分析（n）
类别 病灶数（个） χ2 P 2 3 ≥4 中央区淋巴结 是 227 111 69 56.98 <0.01 否 297 72 12 颈侧区淋巴结 是 85 83 34 70.36 <0.01 否 429 100 37
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表 4 淋巴结转移的危险因素分析
LNa B 标准误 Wald df 显著水平 Exp（B） Exp（B）95%的置信区间 下限 上限 性别 1.235 .268 21.218 1 0.000 3.440 2.034 5.819 淋巴结大小 1.336 .194 47.415 1 0.000 3.805 2.601 5.565 病灶数量 2.287 .242 89.410 1 0.000 9.848 6.130 15.822 单双侧分布 -1.947 .197 97.688 1 0.000 .143 .097 .210
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