Risk factors of cervical lymph node metastasis in papillary thyroid carcinoma
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摘要:
目的探讨甲状腺乳头状癌（PTC）发生中央区与侧颈区淋巴结转移的独立危险因素。 方法回顾性分析247例接受淋巴结根治术的PTC患者，按转移区域将患者分为未转移组（NLNM，n=152）、单纯中央区转移组（CLNM组，n=47）、侧颈区转移组（LLNM组，n=48），单因素分析颈部淋巴结转移的危险因素，多因素分析中央区和侧颈区淋巴结转移的独立危险因素。 结果单因素分析显示年龄、病灶最大径、纵横比、包膜接触对预测颈部淋巴结转移有统计学意义（χ2=27.842、32.554、8.716、30.770，P < 0.05）。多因素分析显示年龄和病灶最大径是预测CLNM及LLNM的独立预测因素（P < 0.05，OR=0.203、2.657）；包膜接触范围仅是LLNM的独立预测因素（P < 0.001，OR=2.090）。年龄与CLNM和LLNM均呈负相关（β=-1.596、-1.285）。 结论年龄 < 45岁、病灶最大径 > 10 mm、包膜接触对颈部淋巴结转移具有重要预测价值。病灶包膜接触范围对于LLNM有显著的预测价值，包膜接触范围越大，发生转移可能越大。 Abstract:ObjectiveTo explore the risk factors of central and lateral cervical lymph node metastasis in papillary thyroid carcinoma (PTC). MethodsA total of 247 patients with PTC were retrospectively analyzed. According to the metastatic region, the patients were divided into three groups: non metastatic group (NLNM, n=152), simple central region metastasis group (CLNM, n=47) and lateral cervical region metastasis group (LLNM, n=48). Univariate analysis was used to analyze the risk factors of cervical lymph node metastasis, and multivariate analysis was used to analyze the independent risk factors of central and lateral cervical lymph node metastasis. ResultsUnivariate analysis showed that age, maximum diameter of lesion, aspect ratio and capsular contact were significantly in predicting cervical lymph node metastasis (P < 0.05). Multivariate analysis showed that age and the maximum diameter of lesion were independent predictors of clnm and llnm (P < 0.05). The capsule contact area was only independent predictor of llnm (P < 0.001, OR=2.090). Age was negatively correlated with clnm and llnm (β=-1.596, -1.285). ConclusionAge < 45 years old, maximum diameter of lesion > 10 mm and capsule contact are important predictors of cervical lymph node metastasis. The larger the contact area, the greater the possibility of metastasis. -
Key words:
- ultrasound /
- papillary thyroid cancer /
- cervical lymph nodes /
- metastasis
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图 1 PTC病灶包膜接触范围分类模式图
A：无接触；B： < 25%接触；C：25%~50%接触；D： > 50%接触
Figure 1. Classification model of PTC lesion capsule contact area.
图 2 PTC伴双侧颈部淋巴结转移超声声像图
A：病灶超声纵切面；B：病灶超声横切面；C：病灶同侧III区淋巴结，回声不均，淋巴门不清；D：对侧颈部III区淋巴结，内部回声不均匀，淋巴门不清，内部可见囊性结构。术后病理证实：PTC，双侧颈部淋巴结转移.
Figure 2. Ultrasonography of PTC with bilateral cervical lymph node metastasis.
表 1 病灶特征与淋巴结转移区域分析
Table 1. Analysis of the relationship between the characteristics of the lesion and lymph node metastasis[n(%)]
指标 NLNM(n=152) CLNM (n=47) LLNM (n=48) χ2 P 性別 1.700 0.427 男 37(24.34) 14(29.79) 16 (23.33) 女 115 (75.66) 33 (70.21) 32 (77.78) 年龄(岁） 27.842 0.000 < 45 56 (36.84) 34 (72.34) 31 (64.58) ≥45 96(63.16) 13 (27.66) 17 (35.42) 病灶大小(mm) 32.554 0.000 ≤10 83 (54.61) 14(29.79) 5 (10.42) > 10 69 (45.39) 33 (70.21) 43 (89.58) 形态 2.095 0.351 规则 45(29.61) 9(19.15) 12(25) 不规则 107(70.39) 38(80.85) 36(75) 边缘 2.123 0.825f 光整 9 (5.84) 1 (2.13) 3 (6.25) 不光整 143(94.16) 46 (97.87) 45 (93.75) 位置 1.917 0.945 上极 29 (19.07) 8 (17.02) 9 (18.75) 中部 86 (56.58) 24 (51.06) 26 (54.17) 下极 35 (23.03) 14(29.79) 12 (25.00) 峡部 2 (1.32) 1 (2.13) 1 (2.08) 纵横比 8.716 0.013 < 1 93(61.18) 36(76.6) 39(81.25) > 1 59(38.82) 11(23.4) 9(18.75) 钙化 5.438 0.240 无钙化 36 (22.88) 8 (17.02) 6 (12.50) 粗大钙化 102 (67.97) 37 (78.72) 35 (72.92) 微钙化 14(9.15) 2 (4.26) 7 (14.58) 包膜接触范围(%) 30.770 < 0.001 0 42 (27.64) 9 (19.15) 3 (6.25) 0~20 43 (28.28) 13 (27.66) 7 (14.58) 20~50 55 (36.19) 16(34.04) 21 (43.75) > 50 12(7.89) 9 (19.15) 17 (35.42) 回声水平 1.026 0.943 等回声 2 (1.32) 0 (0.00) 0 (0.00) 低回声 142(93.42) 45 (95.74) 42 (87.50) 极低回声 8 (5.26) 2 (4.26) 6 (12.50) 内部结构 0.899 0.640 实性 150 (98.68) 46 (97.87) 48 (100.00) 囊实件： 2 (1.32) 1 (2.13) 0 (0.00) 病灶个数 1.783 0.643 单发 129 (84.87) 35 (74.47) 37 (77.08) 多发 23 (15.13) 12 (25.53) 11 (22.92) 合并桥本 1.617 0.446 无 117(76.97) 32(68.09) 31(64.58) 合并 35(23.03) 15(31.91) 17(35.42) 
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表 2 甲状腺乳头状癌颈部淋巴结转移的多元logistic回归分析
Table 2. Multiple logistic regression analysis of cervical lymph node metastasis in papillary thyroid carcinoma (n=247)
变量 β SE Wald P OR 95%CI 下限 上限 NLNM vs CLNM 年龄 -1.596 1月0日 17.183 < 0.0001 0.203 0.095 0.431 大小 0.977 1月0日 5.169 0.023 2.657 1.144 6.168 包膜侵犯范围 0.180 0.200 0.811 0.368 1.197 0.809 1.772 纵横比 -0.130 0.436 0.089 0.766 0.878 0.374 2.064 常量 -0.615 0.823 0.557 0.455 0.541 NLNM vs LLNM 年龄 -1.285 0.397 10.471 0.001 0.277 0.127 0.603 大小 1.803 0.548 10.846 0.001 6.069 2.075 17.750 包膜侵犯范围 0.737 0.232 10.079 0.001 2.090 1.326 3.294 纵横比 0.006 0.479 0.000 0.989 1.006 0.394 2.573 常量 -3.572 1.120 10.167 0.001 0.028 NLNL: 未转移组; CLNM: 单纯中央区转移组; LLNM: 侧颈区转移组.
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