Liu Wen, Cheng Ruochuan, Su Yanjun, Diao Chang, Qian Jun, Zhang Jianming, Ma Yunhai, Fan Yinxia
Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Medicine (Baltimore). 2017 Oct;96(43):e8365. doi: 10.1097/MD.0000000000008365.
Due to the lack of an accurate preoperative diagnostic method of central lymph node metastasis (CLNM) of papillary thyroid cancer (PTC), the prophylaxis of central lymph node dissection remains controversial. The present study investigated the clinicopathological features of PTC patients and the risk factors of CLNM. The clinicopathological features of PTC patients with respect to sex, age, initial symptoms, observation, tumor diameter, multifocality, extrathyroidal invasion, and pathological data combined with other thyroid diseases, were analyzed retrospectively. The risk factors of CLNM were analyzed by Chi-squared test and multivariate logistic regression model. The CLNM rate of PTC was 40.6% (1331/3273). On average, 7.0 (4.0, 12.0) central lymph nodes were dissected, and 3.70 (±3.8) lymph nodes were proved to be metastatic. Univariate analysis showed that sex (P < .001), age (P < .001), tumor diameter (P < .001), extrathyroid invasion (P < .001), multifocality (P = .001), concurrent nodular goiter (P < .001), initial symptoms (P < .001), and observation or not (P < .001) were related to CLNM. The observation time was neither related to CLNM (P = .469) nor extrathyroidal invasion (P = .137). Tumors localized in the lower part of the thyroid were the risk factors for CLNM (P < .001) while multifocality was unrelated (P = .68). The metastasis rate of bilateral multiple regions > unilateral multiple regions > single region (P = .003). Multivariate logistic regression analysis showed that sex, age, tumor diameter, extrathyroidal invasion, and observation were independent risk factors of CLNM. Male, younger age, large tumor size, and extrathyroidal invasion were independent risk factors for CLNM. CLNM was related to multiple regions occupied by tumors in the thyroid but unrelated to multifocality. The tumor occupying a single region and localized in the lower part of thyroid could be used as a predictive factor for CLNM. For tumors that could not be diagnosed as benign or malignant, observation may be an option, since no evidence of disease progression was presented during observation.
由于缺乏准确的术前诊断甲状腺乳头状癌（PTC）中央区淋巴结转移（CLNM）的方法，中央区淋巴结清扫术的预防性应用仍存在争议。本研究调查了PTC患者的临床病理特征及CLNM的危险因素。回顾性分析PTC患者在性别、年龄、初始症状、观察情况、肿瘤直径、多灶性、甲状腺外侵犯以及病理数据并结合其他甲状腺疾病方面的临床病理特征。通过卡方检验和多因素logistic回归模型分析CLNM的危险因素。PTC的CLNM率为40.6%（1331/3273）。平均清扫7.0（4.0，12.0）个中央区淋巴结，其中3.70（±3.8）个淋巴结被证实有转移。单因素分析显示，性别（P＜0.001）、年龄（P＜0.001）、肿瘤直径（P＜0.001）、甲状腺外侵犯（P＜0.001）、多灶性（P = 0.001）、合并结节性甲状腺肿（P＜0.001）、初始症状（P＜0.001）以及是否观察（P＜0.001）与CLNM有关。观察时间与CLNM（P = 0.469）及甲状腺外侵犯（P = 0.137）均无关。位于甲状腺下部的肿瘤是CLNM的危险因素（P＜0.001），而多灶性与之无关（P = 0.68）。双侧多区域转移率＞单侧多区域转移率＞单区域转移率（P = 0.003）。多因素logistic回归分析显示，性别、年龄、肿瘤直径、甲状腺外侵犯及观察情况是CLNM的独立危险因素。男性、年轻、肿瘤体积大及甲状腺外侵犯是CLNM的独立危险因素。CLNM与甲状腺内肿瘤占据的多个区域有关，但与多灶性无关。肿瘤位于甲状腺下部且为单区域可作为CLNM的预测因素。对于无法诊断为良性或恶性的肿瘤，观察可能是一种选择，因为观察期间未出现疾病进展的证据。
