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中华普通外科学文献(电子版) ›› 2020, Vol. 14 ›› Issue (01) : 27 -30. doi: 10.3877/cma.j.issn.1674-0793.2020.01.008

所属专题: 文献

论著

甲状腺乳头状癌跳跃性侧颈区淋巴结转移的危险因素分析
郑福庆1, 张立永1, 谢超1, 王波1, 颜守义1, 赵文新1,()   
  1. 1. 350001 福州,福建医科大学附属协和医院微创中心 血管与甲状腺外科
  • 收稿日期:2019-03-26 出版日期:2020-02-01
  • 通信作者: 赵文新
  • 基金资助:
    福建省医学创新课题项目(2018-CX-17); 福建省社会发展引导性项目(2018Y0035); 福建省卫生计生委青年科研课题项目(2017-2-22); 福建医科大学启航基金项目(2017XQ1037)

Risk factors of skip lateral lymph node metastasis leaping over the central compartment in papillary thyroid carcinoma

Fuqing Zheng1, Liyong Zhang1, Chao Xie1, Bo Wang1, Shouyi Yan1, Wenxin Zhao1,()   

  1. 1. Minimal Invasive Center, Department of Vascular and Thyroid Surgery, Fujian Medical University Union Hospital, Fuzhou 350001, China
  • Received:2019-03-26 Published:2020-02-01
  • Corresponding author: Wenxin Zhao
  • About author:
    Corresponding author: Zhao Wenxin, Email:
引用本文:

郑福庆, 张立永, 谢超, 王波, 颜守义, 赵文新. 甲状腺乳头状癌跳跃性侧颈区淋巴结转移的危险因素分析[J/OL]. 中华普通外科学文献(电子版), 2020, 14(01): 27-30.

Fuqing Zheng, Liyong Zhang, Chao Xie, Bo Wang, Shouyi Yan, Wenxin Zhao. Risk factors of skip lateral lymph node metastasis leaping over the central compartment in papillary thyroid carcinoma[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(01): 27-30.

目的

探究甲状腺乳头状癌(PTC)颈部淋巴结跳跃性转移的临床病理特征及其危险因素。

方法

回顾性分析2015年7月至2018年11月福建医科大学附属协和医院收治的259例PTC患者临床资料,探究跳跃性侧颈区淋巴结转移的危险因素。

结果

PTC颈部淋巴结跳跃性转移的发生率为9.3%(24/259)。单因素分析显示,中央区淋巴结清扫数目在跳跃性转移组中更少(P=0.031);肿瘤最大径<1 cm(P<0.001)及肿瘤位于腺体上部(P=0.012)与PTC患者跳跃性转移的发生有关。多因素分析显示,肿瘤最大径<1 cm(OR=5.934,P<0.001)和肿瘤位于腺体上部(OR=2.812,P=0.023)是PTC患者颈部淋巴结跳跃性转移的独立危险因素。

结论

肿瘤最大径<1 cm和肿瘤位于腺体上部的PTC患者侧颈区淋巴结更易发生跳跃性转移。

Objective

To investigate the clinicopathological features and risk factors of skip metastasis to the lateral compartment without central lymph node metastasis in papillary thyroid carcinoma (PTC).

Methods

The medical records of two hundred and fifty-nine patients with PTC who met inclusion criteria in Fujian Medical University Union Hospital from July 2015 to November 2018 were retrospectively analyzed for the risk factors of skip lateral lymph node metastasis.

Results

The frequency of skip lymph node metastasis was approximately 9.3% (24/259). Univariate analysis showed that the skip metastasis group showed a lower harvested central lymph node number (P=0.031). In addition, skip metastasis was significantly associated with primary tumor size <1 cm (P<0.001) and tumor location in the upper portion of the thyroid (P=0.012). Multivariate analysis showed that primary tumor size <1 cm (OR=5.934, P<0.001) and tumor location in the upper portion of the thyroid (OR=2.812, P=0.023) were the independent risk factors of skip metastasis.

Conclusion

Skip metastasis in PTC is more likely in patients with tumor size <1 cm and tumor location in the upper portion of the thyroid.

表1 非跳跃性转移组与跳跃性转移组间临床资料的单因素分析[例(%)]
项目 非跳跃性转移组 跳跃性转移组 统计值 P
例数 235 24
年龄(岁)< 55 201(85.5) 19(79.2%) 0.690 0.406
≥55 34(14.5) 5(20.8%)
性别(例)
75(31.9) 6(25.0%) 0.484 0.486
160(68.1) 18(75.0%)
BMI(kg/m2)
< 25 181(77.0) 19(79.2%) 0.057 0.811
≥25 54(23.0) 5(20.8%)
合并桥本甲状腺炎
152(64.7) 14(58.3%) 0.381 0.537
83(35.3) 10(41.7%)
肿瘤最大径(cm)
< 1 51(21.7) 15(62.5%) 19.088 <0.001
≥1 184(78.3) 9(37.5%)
被膜侵犯
38(16.2) 6(25.0%) 1.204 0.273
197(83.8) 18(75.0%)
腺外浸润
97(41.3) 11(45.8%) 0.186 0.666
138(58.7) 13(54.2%)
多灶性
97(41.3) 5(20.8%) 3.812 0.051
138(58.7) 19(79.2%)
T分期
1~2 36(15.3) 6(25.0%) 1.502 0.220
3~4 199(84.7) 18(75.0%)
癌灶分布
135(57.4) 11(45.8%) 1.194 0.274
100(42.6) 13(54.2%)
肿瘤位于腺体上部
158(67.2) 10(41.7%) 6.246 0.012
77(32.8) 14(58.3%)
BRAF V600E突变
159(67.7) 19(79.2%) 1.342 0.247
76(32.3) 5(20.8%)
侧颈分区转移
Ⅱ区 135(57.4) 13(54.2%) 0.096 0.757
Ⅲ区 183(77.9) 15(62.5%) 2.858 0.091
Ⅳ区 184(78.3) 16(66.7%) 1.675 0.196
淋巴结数目(个)
中央区清扫 16.0±7.3 12.6±6.0 -2.168 0.031a
中央区转移 7.0±5.0 0 -21.719 <0.001a
侧颈区清扫 40.1±15.5 41.8±14.6 0.487 0.626a
侧颈区转移 5.8±4.1 4.1±5.3 -1.874 0.062a
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