甲状腺乳头状癌胸锁乳突肌-胸骨舌骨肌间淋巴结转移的临床意义

摘要

Objective To explore the clinical significance of metastasis of lymph nodes between sternocleidomastoid and sternohyoid muscle (LNSS) in papillary thyroid cancer (PTC).Methods A total of 175 patients with PTC who underwent thyroidectomy with LNSS dissection were retrospectively analyzed.Univariate and multivariate Logistic regression analyses were used to determine the independent risk factors for LNSS metastasis in PTC.Results The rate of detectable LNSS was 70.9％ (124/175) and metastasis rate was 7.4％ (13/175).Of 13 cases with LNSS metastasis,10 with the coexistence of cervical lymph node metastasis.Univariate Logistic regression analysis showed that multiple focal cancer,tumor located in the lower pole of thyroid,belt-shaped muscle invasion,lateral cervical lymph node metastasis,cN +,the number of cervical lymph nodes with metastasis and the number of lymph nodes with metastasis in level Ⅳ were the risk factors for LNSS metastasis (P ＜ 0.05).Multivariate Logistic regression analysis suggested that tumor located in the lower pole of thyroid and the number of cervical lymph nodes with metastasis ＞ 6 were the independent risk factors for LNSS metastasis (P ＜ 0.05).Given the number of cervical lymph nodes with metastasis as a predictor for the LNSS metastasis,the sensitivity was 92.3％,the specificity was 66.7％ and the accuracy rate was 68.6％.Conclusions LNSS metastasis is commom in PTC,with a metastasis rate of 7.4％.PTC in the lower pole of thyroid and the number of cervical lymph nodes with metastasis ＞ 6 are independent risks for LNSS metastasis.%目的 探讨胸锁乳突肌-胸骨舌骨肌间(lymph node between sternocleidomastoid and sternohyoid muscle,LNSS)淋巴结转移在甲状腺乳头状癌中的临床意义.方法 回顾性分析2010年9月全2016年6月青岛大学附属烟台毓璜顶医院甲状腺外科175例行手术治疗的甲状腺乳头状癌患者LNSS淋巴结的转移情况,分别采用单变量Logistic回归分析和多因素Logistic回归分析的方法确定LNSS淋巴结转移的独立危险因素.结果 入组175例甲状腺乳头状癌患者,LNSS淋巴结检出率为70.9％(124/175),阳性转移率为7.4％(13/175).13例LNSS淋巴结阳性转移的甲状腺乳头状癌患者中,76.9％(10/13)同时发生颈侧区淋巴结转移.行单变量Logistic回归分析提示:多灶性肿瘤、肿瘤位于甲状腺下极、肿瘤侵犯颈前带状肌、颈侧区淋巴结转移、cN+、颈部淋巴结转移数、Ⅳ区淋巴结转移及Ⅳ区淋巴结转移数是LNSS淋巴结转移的危险因素(P＜0.05);进一步行多变量逐步Logistic回归分析提示:肿瘤位于甲状腺下极和颈部淋巴结转移数＞6枚是LNSS淋巴结转移的独立危险因素(P＜0.05);以颈部淋巴结转移数作为LNSS淋巴结转移的预测因子其敏感度为92.3％,特异度为66.7％,准确率为68.6％.结论 甲状腺乳头状癌患者中存在一定比例的LNSS淋巴结转移,尤其是当癌灶位于甲状腺下极以及颈部淋巴结转移数＞6枚时,应当特别注意其患侧LNSS淋巴结的清扫,以提高手术效果、降低复发;对于LNSS淋巴结阳性转移而未行颈侧区淋巴清扫的患者,应在随访期密切关注颈侧区淋巴结是否受累,以便尽早干预,改善患者预后.