208例甲状腺乳头状癌患者颈部淋巴结转移相关因素分析

郭斌; 陈蕊; 王圣应; 彭梅

doi:10.16766/j.cnki.issn.1674-4152.002310

208例甲状腺乳头状癌患者颈部淋巴结转移相关因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002310

郭斌¹,
陈蕊¹,
王圣应²,
彭梅^3, ,

1.
中国科学技术大学附属第一医院(安徽省立医院)超声科，安徽合肥 230031
2.
中国科学技术大学附属第一医院(安徽省立医院)头颈外科，安徽合肥 230031
3.
安徽医科大学第二附属医院超声科，安徽合肥 230000

基金项目:

安徽省重点研究与开发计划项目 201904A07020068

详细信息

通讯作者:
彭梅, E-mail: 13955125956@163.com

中图分类号: R736.1 R730.7
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- 文章访问数: 419
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- PDF下载量: 83
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-16
- 网络出版日期: 2022-03-04

Analysis of factors related to cervical lymph node metastasis in 208 patients with papillary thyroid carcinoma

1.
Ultrasonic Department, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui 230031, China

摘要

摘要: 目的探寻甲状腺乳头状癌(papillary thyroid carcinoma, PTC)患者颈部淋巴结转移的相关因素，为临床治疗决策的拟定及预后评估提供依据。方法收集2019年6—12月在中国科学技术大学附属第一医院(安徽省立医院)头颈乳腺外科收治的208例接受手术治疗且病理证实为PTC首发病例的超声、病理及临床资料，详细记录各项数据，并采用单因素和多因素logistic回归分析研究颈部淋巴结转移组和非转移组的相关因素。结果 208例患者中发生颈部淋巴结转移的有126例，转移率为60.6%。不同性别、年龄、肿瘤位置、肿瘤长径、是否存在超声异常淋巴结、肿瘤纵横比>1、多灶病变、双侧病变、被膜侵犯、结节钙化、合并结节性甲状腺肿的PTC患者，颈部淋巴结转移率差异有统计学意义(均P < 0.05)；多因素logistic分析结果显示：女性(OR=0.386)是PTC患者颈部淋巴结转移的保护因素，肿瘤位置低(OR=3.057)、存在超声异常淋巴结(OR=6.277)、多灶病变(OR=2.889)是PTC患者颈部淋巴结转移的独立危险因素。结论 PTC患者颈部淋巴结转移与多种因素密切相关，关注分析此类因素，对临床分期、拟定治疗决策及预后评估有重要的临床意义。
- 甲状腺乳头状癌 /
- 颈部淋巴结转移 /
- 相关因素
Abstract: Objective To explore the related factors of cervical lymph node metastasis in patients with papillary thyroid carcinoma (PTC), so as to provide the basis for clinical treatment decision-making and prognosis evaluation. Methods The ultrasonic, pathological and clinical data of 208 cases with PTC confirmed by pathology in the First Affiliated Hospital of the University of Science and Technology of China (Anhui Provincial Hospital) from June 2019 to December 2019 were collected. Univariate and multivariate logistic regression analysis was used to analyse the related factors of the cervical lymph node metastasis group and non-metastasis group. Results Amongst the 208 patients, 126 had cervical lymph node metastasis, and the rate of metastasis was 60.6%. A significant difference was observed in the cervical lymph node metastasis rate amongst different gender, age, tumour location, tumour length and diameter, abnormal lymph nodes, tumour aspect ratio >1, multifocal lesions, bilateral lesions, capsule invasion, nodal calcification and PTC patients with nodular goitre (all P < 0.05). The Results of multivariate logistic analysis showed that female (OR=0.386) was a protective factor for cervical lymph node metastasis in patients with PTC, and tumour located in the lower pole(OR=3.057), abnormal lymph nodes in ultrasound (OR=6.277) and multifocal lesions (OR=2.889) were independent risk factors for cervical lymph node metastasis in patients with PTC. Conclusion Cervical lymph node metastasis in PTC patients is closely related to many factors. Paying attention to and analysing these factors have important clinical significance for clinical staging, treatment decision-making and prognosis evaluation.
- Thyroid papillary carcinoma /
- Cervical lymph node metastasis /
- Related factors

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表 1 甲状腺乳头状癌患者颈部淋巴结转移的单因素分析

项目	类别	例数	未转移组(n=82)	转移组(n=126)	统计量	P值
性别[例(%)]	男性	60	15(25.0)	45(75.0)	7.345^a	0.007
	女性	148	67(45.3)	81(54.7)
年龄(x±s，岁)			43.82±10.79	39.89±11.78	2.428^b	0.016
肿瘤长径(x±s，cm)			9.35±5.41	13.50±8.64	-4.257^b	< 0.001
肿瘤位置[例(%)]	上	42	23(54.8)	19(45.2)	11.094^a	0.004
	中	77	35(45.5)	42(54.5)
	下	89	24(27.0)	65(73.0)
肿瘤纵横比[A/T > 1，例(%)]	否	115	38(33.0)	77(67.0)	4.383^a	0.036
	是	93	44(47.3)	49(52.7)
超声异常淋巴结[例(%)]	否	135	73(54.1)	62(45.9)	34.574^a	< 0.001
	是	73	9(12.3)	64(87.7)
多灶病变[例(%)]	否	95	51(53.7)	44(46.3)	14.892^a	< 0.001
	是	113	31(27.4)	82(72.6)
双侧病变[例(%)]	否	144	67(46.5)	77(53.5)	9.892^a	0.002
	是	64	15(23.4)	49(76.6)
被膜侵犯[例(%)]	否	95	46(48.4)	49(51.6)	5.928^a	0.015
	是	113	36(31.9)	77(68.1)
结节边界清晰[例(%)]	否	178	70(39.3)	108(60.7)	0.005^a	0.944
	是	30	12(40.0)	18(60.0)
结节形态规则[例(%)]	否	170	62(36.5)	108(63.5)	3.397^a	0.065
	是	38	20(52.6)	18(47.4)
结节血流丰富[例(%)]	否	33	17(51.5)	16(48.5)	2.402^a	0.121
	是	175	65(37.1)	110(62.9)
结节钙化[例(%)]	否	39	22(56.4)	17(43.6)	5.800^a	0.016
	是	169	60(35.5)	109(64.5)
合并桥本氏甲状腺炎[例(%)]	否	142	51(35.9)	91(64.1)	2.306^a	0.129
	是	66	31(47.0)	35(53.0)
合并结节性甲状腺肿[例(%)]	否	167	60(35.9)	107(64.1)	4.333^a	0.037
	是	41	22(53.7)	19(46.3)
血清甲状腺球蛋白水平[例(%)]	<3.50 μg/L	39	19(48.7)	20(51.3)	1.333^c	0.183
	3.50~77.00 μg/L	145	55(37.9)	90(62.1)
	>77.00 μg/L	24	8(33.3)	16(66.7)
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 Logistic回归分析变量赋值表

项目	赋值方法
性别	男性=1；女性=2
年龄(岁)	以实际值赋值
肿瘤长径(cm)	以实际值赋值
肿瘤位置	上=(0，0)；中=(0，1)；下=(1，0)
肿瘤纵横比(A/T > 1)	否=1；是=2
超声见异常淋巴结	否=1；是=2
多灶病变	否=1；是=2
双侧病变	否=1；是=2
被膜侵犯	否=1；是=2
结节钙化	否=1；是=2
合并结节性甲状腺肿	否=1；是=2

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表 3 甲状腺乳头状癌患者颈部淋巴结转移影响因素的logistic回归分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
性别(女)	-0.953	0.410	5.390	0.020	0.386	0.173~0.862
年龄	-0.017	0.017	1.104	0.293	0.983	0.951~1.015
肿瘤长径	0.048	0.029	2.703	0.100	1.049	0.991~1.111
肿瘤位置(中)^a	0.505	0.480	1.105	0.293	1.657	0.646~4.246
肿瘤位置(下)^a	1.117	0.475	5.544	0.019	3.057	1.206~7.748
肿瘤纵横比(A/T) > 1	-0.369	0.381	0.939	0.333	0.691	0.328~1.459
超声异常淋巴结	1.837	0.454	16.347	< 0.001	6.277	2.577~15.293
多灶病变	1.061	0.436	5.929	0.015	2.889	1.230~6.788
双侧病变	-0.137	0.515	0.070	0.791	0.872	0.318~2.394
被膜侵犯	0.307	0.355	0.749	0.387	1.360	0.678~2.728
结节钙化	0.023	0.456	0.003	0.959	1.024	0.419~2.501
合并结节性甲状腺肿	-0.321	0.454	0.501	0.479	0.725	0.298~1.765
注：^a肿瘤位置以“上”作为参照。

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