Risk Factors for Neck Nodal Metastasis in Papillary Thyroid Microcarcinoma: A Study of 1066 Patients
Risk Factors for Neck Nodal Metastasis in Papillary Thyroid Microcarcinoma: A Study of 1066 Patients
复制标题
甲状腺微小乳头状癌颈部淋巴结转移的危险因素：一项针对 1066 名患者的研究
DOI：
10.1210/jc.2011-1546
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发表时间：
2012-04-01
影响因子：
5.8
通讯作者：
Wu, Yi
中科院分区：
文献类型：
--
作者：
Zhang, Ling;Wei, Wen-jun;Wu, Yi
内容：甲状腺乳头状微小癌（PTMC）的外科治疗，特别是中央淋巴结清扫的必要性，仍然存在争议。目的：本研究的目的是描述PTMC的临床病理特征，并确定中央淋巴结转移（CLNM）的危险因素，以指导PTMC患者的外科治疗策略。设计：在这项回顾性横断面研究中，在原发肿瘤手术时评估风险因素和结果变量。设置：该研究在一所大学三级护理癌症医院进行。患者：结果：多因素Logistic回归分析发现男性、年龄小于6 mm与CLNM相关;多灶性病变与最高风险相关（比值比4.476，95%置信区间2.975-6.735）。甲状腺外侵犯、多灶性病变和CLNM与侧颈淋巴结转移（LLNM）相关。在孤立性原发性肿瘤患者中，肿瘤位置在甲状腺叶的上三分之一与CLNM的风险较低和LLNM的风险较高相关。结论：预防性中央淋巴结清扫需要考虑PTMC患者的危险因素。在PTMC患者的孤立性原发肿瘤，肿瘤的位置可以帮助评估LLNM。我们建议多中心研究和长期随访，以更好地了解PTMC的危险因素和手术治疗。（J Clin Endocrinol Metab 97：1250-1257，2012）
Context: The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central lymph node dissection, remains controversial.Objective: The objective of the study was to describe the clinicopathological features of PTMC and to identify the risk factors for central lymph node metastasis (CLNM) that can guide surgical strategies for patients with PTMC.Design: In this retrospective cross-sectional study, risk factors and outcome variables were assessed at the time of surgery for the primary tumor.Setting: The study was conducted at a university-based tertiary care cancer hospital.Patients: Data from the medical records of 1066 consecutive patients diagnosed with PTMC over a 5-yr period were analyzed.Results: Our multivariate logistic regression analysis found male gender, younger age (6 mm) to be associated with CLNM; multifocal lesions were associated with the highest risk (odds ratio 4.476, 95% confidence interval 2.975-6.735). Extrathyroidal extension, multifocal lesions, and CLNM were associated with lateral neck lymph node metastasis (LLNM). In patients with a solitary primary tumor, tumor location in the upper third of the thyroid lobe was associated with a lower risk of CLNM and a higher risk of LLNM.Conclusions: Prophylactic central lymph node dissection need be considered in PTMC patients presenting with risk factors. In PTMC patients with a solitary primary tumor, tumor location can assist in the evaluation of LLNM. We recommend multicenter research and long-term follow-up to better understand the risk factors and surgical management of PTMC. (J Clin Endocrinol Metab 97: 1250-1257, 2012)