甲状腺微小乳头状癌中央区淋巴结转移相关因素及其预测能力分析

摘要

目的 探讨甲状腺微小乳头状癌(PTMC)中央区淋巴结转移相关因素及其预测能力.方法 回顾性分析2012年3月至2016年8月首都医科大学附属北京安贞医院普外科243例PTMC手术患者的临床资料.分析手术时年龄、性别、肿瘤大小、病灶数量和被膜外侵犯等因素对PTMC中央区淋巴结转移的预测能力,并结合MACIS和AGES评分系统分别进行综合评判,分析以上指标与淋巴结转移的相关关系.结果 243例PTMC病例中男66例、女177例,淋巴结转移发生率为38.7％(94/243).以是否发生中央区淋巴结转移分为转移组(94例)和未转移组(149例)进行分析.手术时年龄小[(41±10)岁比(45±12)岁]、肿瘤最大径大[7(1,10) mm比6(1,10) mm]和多发病灶[44.7％ (42/94)比24.2％(36/149)]与发生淋巴结转移有关,组间差异有统计学意义(P =0.003、0.002、0.017);性别、是否侵犯被膜、MACIS评分、AGES评分与淋巴结转移不相关,组间差异无统计学意义(P =0.186、0.404、0.149、0.733).受试者工作特征曲线分析显示,年龄为44.5岁时敏感度+特异度为最大值;肿瘤最大径为5.5 mm时敏感性+特异性为最大值.结论 年龄＜45岁、肿瘤最大径≥6 mm及多发癌灶与PTMC淋巴结转移发生率增加相关.%Objective To explore influence factors of central neck lymph node metastasis of papillary thyroid microcarcinoma(PTMC).Methods A retrospective study was conducted in 243 patients with PTMC who were operated in Department of General Surgery,Beijing Anzhen Hospital,Capital Medical University from March 2012 to August 2016.Clinical data including age,sex,tumor size,tumor numbers and extracapsular spread were recorded;MACIS and AGES scoring systems were assessed in all patients;correlation among these factors and central lymph node metastasis was analyzed.Results There were 66 males and 177 females;the lymph node metastasis rate was 38.7％ (94/243).Based on analysis between metastasis group (94 cases) and non-metastasis group (149 cases),age [(41 ± 10) years old vs (45 ± 12) years old],maximum diameter of tumor [7 (1,10) mm vs 6(1,10)mm] and multiple foci[44.7％ (42/94) vs 24.2％ (36/149)] were related to lymph node metastasis (P =0.003,0.002,0.017);sex,extracapsular spread,MACIS score and AGES score had no significant differences between groups(P =0.186,0.404,0.149,0.733).Receiver operating characteristic curve presented the highest sensitivity and specificity when age was 44.5 years old and maximur m diameter of tumor was 5.5 mm.Conclusion Age ＜45 years old,tumor diameter≥6 mm and multiple foci are related to lymph node metastasis.