甲状腺微小乳头状癌颈部淋巴结转移的相关因素分析

摘要

Objective To analyze thyroid papillary carcinoma (PTMC) neck lymph node metastasis (LNM) related factors,and further to explore the diagnostic value of ultrasonography in LNM.Methods A retrospective analysis of 384 cases of patients with PTMC confirmed by pathology and ultrasonic data were performed,according to the presence of cervical lymph node metastasis,they were divided into transfer group (116 cases) and nontransfer group (268 cases).Analysis was made to summarize the clinical and sonographic features of the two groups.Chi-square test and the multi-factor Logistic regression analysis were used to study the risk factors.Results ①The single factor analysis of sonographic features showed that the factors of gender (X 2 = 3.893,P = 0.048),age (P = 0.001),tumor diameter (P = 0.008), boundary(X 2 =6.327,P =0.012),acoustic halo (X2 = 15.562,P =0.001),and place (X 2 =9.441 ,P =0.024) were statistical different between the two groups;②Multiariable Logistic regression analysis showed that:patient age,tumor diameter,and acoustic halo were independent risk factors for PTMC neck lymph node metastasis,if Logistic model was used to predict the probability P =0.50 as a threshold,its accuracy was 74.2%,and the area under the ROC curve was 0.744.Conclusions Patients with age ≤ 45 years, tumor diameter ≥ 0.7 cm,located in the lower pole,boundary with uneven acoustic halo,were prone to LNM,and easy to Ⅵ area,suggest preventive cleaning lymph node in central region.%目的 分析甲状腺微小乳头状癌(PTMC)颈部淋巴结转移(LNM)的相关因素,进一步探讨超声对LNM的诊断价值.方法 回顾性分析经病理及超声资料证实的PTMC患者384例,根据有无颈部淋巴结转移分为转移组(116例)与未转移组(268例).分析总结两组的临床及超声特征,应用X2检验和多因素Logistic回归模型分析颈部淋巴结转移的危险因素.结果 ①超声特征的单因素分析显示:患者性别(X2=3.893,P=0.048)、年龄(P=0.001)、肿瘤最大直径(P=0.008)、边界(X2=6.327,P=0.012)、声晕(X2=15.562,P=0.001)、部位(X2=9.441,P=0.024)两组间比较差异有统计学意义;②多因素Logistic回归分析显示:患者年龄、肿瘤最大直径、部位、声晕为PTMC颈部淋巴结转移的独立危险因素,Logistic模型以预测概率P=0.50作为阈值,准确率达74.2%,ROC曲线下面积0.744.结论 年龄≤45岁,肿瘤最大直径≥0.7 cm、位于下极、边界具有不均匀声晕的患者易发生LNM,且易转移至Ⅵ区,建议行预防性中央区淋巴结清扫.