Predictive factors of skip metastasis to lateral with leaping central lymph node in papillary thyroid carcinoma
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摘要:
目的 探讨甲状腺乳头状癌（papillary thyroid carcinoma，PTC）淋巴结跳跃转移（中央区无淋巴结转移，颈侧区有淋巴结转移）的规律及危险因素。 方法 回顾性分析2013年1月至2016年12月重庆医科大学附属第一医院521例行甲状腺全切+中央区及颈侧区淋巴结清扫的PTC患者的临床病理资料，分析跳跃转移的危险因素。 结果 本研究PTC跳跃转移率为8.3%（43/521），肿瘤位于甲状腺上极（OR=3.401，95%CI：1.770~6.536；P=0.001），年龄>45岁（OR=2.856，95%CI：1.488~5.482；P=0.002），单侧癌（OR=3.424，95%CI：1.182~9.920；P=0.023）是PTC出现颈侧区淋巴结跳跃转移的独立危险因素。本研究比较cN1b的PTC患者和肿瘤位于甲状腺上极的cN0 PTC患者跳跃转移情况，发现肿瘤位于上极cN0的PTC患者出现潜在跳跃转移的可能性高于cN1b患者（P=0.022）。 结论 PTC颈侧区淋巴结跳跃转移并不少见，术前、术中针对颈侧区淋巴结转移状态的评估很重要，尤其是肿瘤位于上极，年龄>45岁的单侧PTC患者，必要时需行患侧颈侧区淋巴结清扫。 Abstract:Objective To retrospectively analyze the regularity and risk factors of skip metastasis (central lymph node negative and lateral lymph node positive) in papillary thyroid carcinoma (PTC). Methods A total of 521 PTC patients underwent total thyroidectomy and central plus lateral lymph node dissection at The First Affiliated Hospital of Chongqing Medical University from January 2013 to December 2016. Clinicopathological characteristics of the patients were collected and analyzed. Results Skip metastasis rate of PTC was 8.3% (43/521). Tumors in the upper lobe (OR=3.401, 95%CI: 1.770-6.536; P=0.001) and in the lateral part (OR=3.424, 95%CI: 1.182-9.920; P=0.023) of the thyroid, as well as age above 45 (OR=2.856, 95%CI: 1.488-5.482; P=0.002), were independent risk factors for skip metastases for this disease. Clinically node-negative (cN0) PTC patients with tumors in the upper lobe had higher possibility of skip metastases than those with clinically involved lateral neck nodes(cN1b) (P=0.022). Conclusion Skip metastasis of PTC is not uncommon. Thus, preoperative clinical assessment and imaging examination for lateral lymph node is necessary, especially for PTC patients who are above 45 years old and with tumors in the upper lobe and/or unilateral area of thyroid. The lateral lymph node dissection should be performed when necessary. -
Key words:
- papillary thyroid carcinoma /
- central lymph node /
- lateral lymph node /
- skip metastasis
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表 1 甲状腺乳头状癌颈侧区淋巴结跳跃转移危险因素的分析
Table 1. Analysis of risk factors for skip metastasis in the lateral lymph node of PTC patients
表 2 甲状腺乳头状癌跳跃转移危险因素的多因素分析
Table 2. Multivariate analysis of factors contributing to skip metastasis of PTC
表 3 颈侧区淋巴结跳跃转移的分布情况
Table 3. Distribution of skip metastasis
表 4 肿瘤位于甲状腺上极跳跃转移分布情况
Table 4. Distribution of skip metastasis when tumor is located in the upper lobe of the thyroid
表 5 肿瘤位于甲状腺中部及下极跳跃转移分布情况
Table 5. Distribution of skip metastasis when tumor is located in the middle and lower lobe of the thyroid
表 6 cN1b甲状腺乳头状癌患者及cN0肿瘤位于甲状腺上极患者淋巴结跳跃转移情况
Table 6. Skip metastases of cN1b PTC patients and cN0 patients with tumor in the upper lobe of the thyroid
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