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甲状腺乳头状癌颈部Ⅴ区淋巴结转移危险因素分析

Predictors of level V lymphatic metastasis in papillary thyroid carcinoma

摘要:

目的 探讨甲状腺乳头状癌颈部Ⅴ区淋巴结转移的预测因素,为确定甲状腺乳头状癌患者清扫Ⅴ区淋巴结的指征寻找依据.方法 回顾性分析2004年3月至2010年11月资料完整的122例甲状腺乳头状癌患者的临床病理资料.其中男性31例,女性91例;年龄8~87岁,中位年龄38.5岁.每个病例至少行一侧Ⅱ~Ⅵ区颈淋巴结清扫术,13例行Ⅰ~Ⅵ区颈淋巴结清扫术,19例行双侧颈淋巴结清扫术.用x2检验对患者年龄、性别、术前远处转移、术后TNM分期、原发灶大小、癌灶多发、肿瘤浸润情况、中央区及同侧Ⅱ~Ⅳ区淋巴结转移情况与Ⅴ区淋巴结转移进行单因素分析,用二分类Logistic回归对单因素分析中有统计学意义的指标进行多因素分析.结果 甲状腺乳头状癌患者Ⅴ区淋巴结转移组与未转移组在年龄、性别、癌灶多发、中央区淋巴结转移、同侧Ⅱ区淋巴结转移、同侧Ⅲ区淋巴结转移及术后TNM分期等因素比较中差异无统计学意义(x2=0.882~3.167,P>0.05),而在肿瘤浸润被膜、浸润甲状腺外组织、术前远处转移、原发灶>4.0cm、同侧Ⅳ区淋巴结转移及同侧Ⅱ、Ⅲ、Ⅳ区淋巴结同时转移等因素中差异有统计学意义(x2 =4.223~ 13.748,P<0.05).多因素分析显示,肿瘤浸润甲状腺外组织(OR =8.32,95% CI:2.44 ~28.3,P=0.001)和同侧Ⅱ、Ⅲ、Ⅳ 区淋巴结同时转移(OR=7.81,95%CI:2.11 ~28.8,P=0.002)是Ⅴ区淋巴结转移的高危因素.结论 肿瘤浸润甲状腺外组织及同侧Ⅱ、Ⅲ、Ⅳ区淋巴结同时转移是甲状腺乳头状癌患者Ⅴ区淋巴结转移的危险因素,对于这一类患者建议行Ⅴ区淋巴结清扫.

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abstracts:

Objective To study the predictors of level Ⅴ metastasis in papillary thyroid carcinoma (PTC).Methods The clinic data of 122 patients with PTC who underwent therapeutic lateral neck dissection between March 2004 and November 2010 was analyzed retrospectively.There were 31 male and 91 female patients.The median age at diagnosis was 38.5 years ( ranging from 8 to 87 years).All the patients had undergone unilateral or bilateral lymph node dissection ( Ⅱ-Ⅵ or Ⅰ-Ⅵ ).Univariate analysis and multivariate analysis were performed using x2 test and binary Logistic regression test,respectively.Result The level Ⅴ metastases was significantly associated with capsular invasion,extrathyroidal extension,preoperative distant metastasis,the size of primary,ipsilateral level Ⅳ lymph node metastasis and simultaneous metastases to ipsilateral level Ⅱ,Ⅲ and Ⅳ ( x2 =4.223-13.748,P < 0.05 ).Age,sex,tumor-multifocal,pTNM,central lymph node metastases ipsilateral level Ⅱ lymph node metastases and ipsilateral level Ⅲ lymph node metastases were not found to be associated with level Ⅴ metastases (x2 =0.882-3.167,P >0.05 ).In multivariate analysis,extrathyroidal extension ( OR =8.32,95% CI:2.44-28.3,P=0.001 ) and simultaneous me tastases to ipsilateral level Ⅱ,Ⅲ and Ⅳ (OR =7.81,95% CI:2.11-28.8,P =0.002 ) were independent predictors of level Ⅴ metastasis.Conclusions Extrathyroidal extension,simultaneous metastases to ipsilateral level Ⅱ,Ⅲ and Ⅳ are risk factors for level Ⅴ lymph nodes metastases in PTC.Dissection of level Ⅴ lymph nodes should be considered for PTC patients with extrathvroidal extension and simultaneous metastases to ipsilateral level Ⅱ,Ⅲ and Ⅳ.

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