Yu Xiaolong, Song Xuejia, Sun Wenhai, Zhao Shihua, Zhao Jiajun, Wang Yan-Gang
Department of Endocrinology and Metabolism, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China.
Department of Endocrinology, First People's Hospital of Qingdao Economic and Technological Development Zone, Qingdao, China.
Horm Metab Res. 2017 Mar;49(3):201-207. doi: 10.1055/s-0043-101917. Epub 2017 Mar 28.
The incidence of papillary thyroid microcarcinoma (PTMC) has risen rapidly in recent years, and PTMC patients with central lymph node metastasis (CLNM) usually have poor prognosis. Independent risk factors predicting CLNM in PTMC have not been well understood. The aim of our study was to identify useful clinicopathological risk factors predicting CLNM in PTMC patients. This was a retrospective study of 917 patients with PTMC treated with surgery from January 2014 to December 2015 in our hospital. The relationship between clinicopathological factors and CLNM was analyzed to identify those factors predicting CLNM in PTMC. Univariate and multivariate logistic regression analyses were further performed. Of 917 PTMC patients, 344 (37.5%) were found to have CLNM confirmed by intraoperative frozen-section examination. Multivariate logistic regression analyses further found several independent factors predicting CLNM in PTMC patients, including male gender (OR=1.75, 95% CI 1.17-2.61; p=0.006), younger age (<45 years) (OR=1.69, 95%CI 1.20-2.38; p=0.002), positive CLNM on ultrasonography (OR=10.20, 95% CI 5.51-18.88; p<0.001), multifocality (OR=1.69, 95% CI 1.00-2.85; p=0.04), and larger tumor size (>5 mm) (OR=2.80, 95% CI 2.01-3.91; p<0.001). The findings of our study identified several useful and independent risk factors predicting CLNM in PTMC patients, such as male gender, younger age, multifocality, positive CLNM on ultrasonography, and larger tumor size. The CLNM is very common in PTMC patients, and routine prophylactic central neck dissection may be recommended in PTMC patients with those independent risk factors of CLNM.
近年来，甲状腺微小乳头状癌（PTMC）的发病率迅速上升，且发生中央区淋巴结转移（CLNM）的PTMC患者通常预后较差。目前对于预测PTMC发生CLNM的独立危险因素尚未完全明确。本研究的目的是确定预测PTMC患者发生CLNM的有用临床病理危险因素。这是一项对2014年1月至2015年12月在我院接受手术治疗的917例PTMC患者的回顾性研究。分析临床病理因素与CLNM之间的关系，以确定那些预测PTMC发生CLNM的因素。进一步进行单因素和多因素逻辑回归分析。在917例PTMC患者中，344例（37.5%）经术中冰冻切片检查证实发生CLNM。多因素逻辑回归分析进一步发现了几个预测PTMC患者发生CLNM的独立因素，包括男性（OR=1.75，95%CI 1.17-2.61；p=0.006）、较年轻年龄（<45岁）（OR=1.69，95%CI 1.20-2.38；p=0.002）、超声检查CLNM阳性（OR=10.20，95%CI 5.51-18.88；p<0.001）、多灶性（OR=1.69，95%CI 1.00-2.85；p=0.04）以及肿瘤较大（>5 mm）（OR=2.80，95%CI 2.01-3.91；p<0.001）。我们研究的结果确定了几个预测PTMC患者发生CLNM的有用且独立的危险因素，如男性、较年轻年龄、多灶性、超声检查CLNM阳性以及肿瘤较大。CLNM在PTMC患者中非常常见，对于具有这些CLNM独立危险因素的PTMC患者，可能建议进行常规预防性中央区颈淋巴结清扫。
