cN0甲状腺微小乳头状癌多个淋巴结转移的危险因素分析

张磊; 杨进宝; 孙庆贺; 刘跃武; 陈革; 陈曙光; 刘子文; 李小毅

doi:10.3969/j.issn.1000-8179.2017.16.352

cN0甲状腺微小乳头状癌多个淋巴结转移的危险因素分析

Risk factors for high-volume lymph node metastases in cN0 papillary thyroid microcarcinoma

摘要

摘要:
目的术后病理证实的淋巴结转移在临床淋巴结转移阴性（clinical lymph node negative，cN0）的甲状腺乳头状癌（papillary thyroid carcinoma，PTC）中并不罕见，本研究旨在探讨临床淋巴结转移阴性的甲状腺微小乳头状癌（papillary thyroid microcarcinoma，PTMC）淋巴结转移的危险因素，特别是多个淋巴结转移（>5枚）的危险因素。
方法回顾性分析中国医学科学院北京协和医院2013年11月至2014年10月行手术的cN0 PTMC患者1 268例，其中男性270例，女性998例。分析患者的临床病理学特征，通过单因素、多因素分析寻找淋巴结转移及多个转移的风险因素。
结果 1 268例患者中共出现淋巴结转移416例（32.8%），多个淋巴结转移43例（3.4%），淋巴结转移的危险因素的单因素分析中，男性（42.22% vs. 30.26%，P < 0.01）、年龄 < 40岁（ < 40岁为48.39%，40~59岁为27.62%，年龄≥60岁为22.45%，P < 0.03）、多发病灶（41.00% vs. 29.03%，P < 0.01）、无慢性淋巴细胞性甲状腺炎（36.44% vs. 20.62%，P < 0.01）、肿瘤直径>0.5 cm（35.77% vs. 23.05%，P < 0.01）者淋巴结转移比例显著增加。多因素分析中，男性（OR=1.516，P < 0.001）、多发病灶（OR=1.743，P < 0.001）、肿瘤直径>0.5 cm（OR=1.788，P < 0.001）是淋巴结转移的独立危险因素；而年龄较大患者（40~59岁OR=0.388；60岁及以上OR=0.301，P < 0.001）、慢性淋巴细胞性甲状腺炎（OR=0.472，P < 0.001）是出现淋巴结转移的保护性因素。在多个淋巴结转移危险因素的多因素分析中，男性（OR=2.383，P=0.002）是多个淋巴结转移的独立危险因素；而年龄≥40岁则是保护性因素（OR=0.270，P < 0.001）。
结论 cN0 PTMC淋巴结转移并不少见，但是多个淋巴结转移少见，男性、年龄 < 40岁的患者淋巴结转移、多个转移的风险明显增加。

Abstract:
Objective Lymph node metastasis (LNM) often occurs in cN0 papillary thyroid microcarcinoma (PTMC). The risk factors for lymph node metastasis, especially for high-volume metastasis, were investigated in this study.
Methods The medical records of 1, 268 consecutive PTMC patients admitted in the Peking Union Medical College Hospital from 2013 to 2014 were reviewed. Their clinical and pathological features were collected. Univariate and multivariate analyses were performed to identify the risk factors for LNM/highvolume LNM.
Results Of the 1, 268 patients, 416 patients (32.8%) and 43 (3.4%) had LNM and high-volume LNM, respectively. According to the univariate analysis results for the risk factors of LNM, male (42.22% vs. 30.26%, P < 0.01), < 40 years ( < 40 years, 48.39%; 40-59 years, 27.62%; ≥60 years 22.45%, P < 0.03), multifocality (41.00% vs. 29.03%, P < 0.01), without chronic thyroiditis (36.44% vs. 20.62%, P < 0.01), tumor size >0.5 cm (35.77% vs. 23.05%, P < 0.01) were associated with LNM. Meanwhile, according to the multivariate analysis results, male, multifocality, and tumor size >0.5 cm are independent risk factors for LNM (OR=1.516, 1.743, and 1.788, respectively, all P < 0.05). The protective factors for LNM are 40-59 years, ≥60 years, and chronic thyroiditis (OR 0.388, 0.301, and 0.472, respectively, all P < 0.05). In the univariate analysis of risk factors for high-volume LNM, the results indicated that being male (6.30% vs. 2.61%, P= 0.005), < 40 years ( < 40 years, 7.62%; 40-59 years, 2.05%; ≥60 years 0, P < 0.001), and tumor size >0.5 cm (4.01% vs. 1.36%, P=0.027) are associated with high-volume LNM. In multivariate analysis, the results suggest that being male is an independent risk factor for LNM (OR=2.383, P=0.002), whereas age of 40-59 years is a protective factor for LNM (OR=0.270, P < 0.001).
Conclusion Lymph node metastasis often ocucrs in cN0 PTMC, whereas high-volume LNM is rare. Being male and < 40 years old are risk factors for both LNM and highvolume LNM.

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