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中华医学超声杂志(电子版) ›› 2020, Vol. 17 ›› Issue (09) : 848 -853. doi: 10.3877/cma.j.issn.1672-6448.2020.09.006

所属专题: 文献

浅表器官超声影像学

甲状腺乳头状癌术前超声特征及术后复发的危险因素
孔繁亮1, 杨敬春,1, 常莹1, 张佳琪1, 马慧娟1   
  1. 1. 100053 北京,首都医科大学宣武医院超声诊断科
  • 收稿日期:2020-05-11 出版日期:2020-09-01
  • 通信作者: 杨敬春
  • 基金资助:
    首都市民健康培育(Z161100000116060)

Preoperative ultrasonographic characteristics and risk factors for postoperative recurrence of thyroid papillary carcinoma

Fanliang Kong1, Jingchun Yang,1, Ying Chang1, Jiaqi Zhang1, Huijuan Ma1   

  1. 1. Department of Ultrasound, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2020-05-11 Published:2020-09-01
  • Corresponding author: Jingchun Yang
  • About author:
    Corresponding author: Yang Jingchun, Email:
引用本文:

孔繁亮, 杨敬春, 常莹, 张佳琪, 马慧娟. 甲状腺乳头状癌术前超声特征及术后复发的危险因素[J/OL]. 中华医学超声杂志(电子版), 2020, 17(09): 848-853.

Fanliang Kong, Jingchun Yang, Ying Chang, Jiaqi Zhang, Huijuan Ma. Preoperative ultrasonographic characteristics and risk factors for postoperative recurrence of thyroid papillary carcinoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(09): 848-853.

目的

分析甲状腺乳头状癌(PTC)的术前超声特征及术后复发的危险因素。

方法

选取2015年1月至2018年12月宣武医院收治的甲状腺乳头状癌患者320例,依据随访结果,将其分为未复发组292例和复发组28例。分别记录2组患者的性别、年龄、超声特征(肿瘤内部构成、回声、边界、形态、微小钙化、纵横比、TI-RADS分类4a~4b及4c~5)及病理特征(病灶大小、多灶性、被膜外侵犯、颈部淋巴结转移、手术方式),采用Cox比例风险回归分析术后复发的危险因素。

结果

320例患者中有28例复发,复发率为8.75%。Cox单因素分析结果显示,4c~5 PTCs、肿瘤囊性变、肿瘤边界、纵横比、肿瘤大小、颈部淋巴结转移及手术方式均为肿瘤复发的危险因素(P<0.001、<0.001、=0.002、=0.006、=0.003、<0.001、=0.035);多因素Cox比例风险回归分析结果显示,4c~5 PTCs、肿瘤囊性变、肿瘤大小、颈部淋巴结转移均是肿瘤复发的独立危险因素(P=0.009、<0.001、=0.001、=0.005)。

结论

PTC恶性超声特征越多,其复发可能性越大,其中TI-RADS 4c~5是PTC复发的独立危险因素。此外,肿瘤囊性变、肿瘤大小、颈部淋巴结转移均有助于预测肿瘤预后。

Objective

To analyze the preoperative ultrasonographic characteristics and risk factors for postoperative recurrence of papillary thyroid carcinoma (PTC) .

Methods

A total of 320 patients with thyroid papillary carcinoma admitted to Xuanwu Hospital from January 2015 to December 2018 were selected. According to follow-up results, the patients were divided into either a recurrence group (n=292) or a non-recurrence group (n=28). Data including gender, age, tumor composition, ultrasound characteristics (echo, boundary, morphology, microcalcification, long-to-short dimension ratio, TI-RADS 4a-4b, and TI-RADS 4c-5), and pathological features (size of lesion, multifocal lesions, extra-membranous invasion, cervical lymph node metastasis, and surgical methods) were recorded. The risk factors for postoperative recurrence were identified, and the correlation between postoperative recurrence of thyroid papillary carcinoma and preoperative ultrasonic characteristics was analyzed.

Results

Among the 320 patients included, 28 (8.75%) had recurrence. Univariate analysis showed that TI-RADS 4c-5, tumor cystic degeneration, tumor boundary, long-to-short dimension ratio, tumor size, cervical lymph node metastasis, and surgical method were risk factors for PTC recurrence (P<0.001, <0.001, =0.002, =0.006, =0.003, <0.001, and =0.035, respectively). Multivariate Cox proportional risk analysis demonstrated that TI-RADS 4c-5 (P=0.009), tumor cystic degeneration (P<0.001), tumor size (P=0.001), and cervical lymph node metastasis (P=0.005) were independent risk factors for recurrence.

Conclusion

More malignant ultrasound features of PTC suggest a greater possibility of recurrence. TI-RADs 4c-5 is an independent risk factor for recurrence in PTC patients. Cystic degeneration, tumor size, and cervical lymph node metastasis are predictive factors for PTC recurrence.

图1 患者,女性,21岁,甲状腺乳头状癌术后5个月癌结节复发并颈部淋巴结转移超声图像。图a示癌结节复发(箭头所示);图b为颈部淋巴结转移(箭头所示)
图2 患者,女性,48岁,甲状腺乳头状癌术后10个月癌结节复发超声图像(箭头所示为癌结节复发病灶)
图3 女性,24岁,甲状腺乳头状癌术后11个月颈部淋巴结转移超声图像(箭头所示为颈部淋巴结转移病灶)
表1 TI-RADS 4a~4b PTCs与4c~5 PTCs组间一般资料及超声和病理特征比较[例(%)]
表2 PTC复发组与未复发组一般资料及超声和病理特征比较[例(%)]
特征 ? 未复发组 复发组 统计值 P
例数 292 28 ? ?
年龄(岁,±s ? ? ? ?
? 总平均年龄 42.59±12.23 38.29±15.87 t=1.836 0.500
? 男性平均年龄 43.58±12.06 39.00±19.80 t=1.924 0.305
? 女性平均年龄 42.23±12.18 41.17±15.25 t=4.656 0.006
性别 ? ? χ2=1.833 0.176
? 男性 48(16.4) 8(28.6) ? ?
? 女性 244(83.6) 20(71.4) ? ?
肿瘤内部构成 ? ? - 0.001
? 完全实性 288(98.6) 20(71.4) ? ?
? 囊性变 4(1.4) 8(28.6) ? ?
边界 ? ? χ2=11.696 0.001
? 140(47.9) 4(14.3) ? ?
? 不清 152(52.1) 24(85.7) ? ?
形态 ? ? χ2=11.636 0.001
? 规则 88(30.1) 0(0) ? ?
? 不规则/分叶/毛刺/成角 204(69.9) 28(100.0) ? ?
钙化 ? ? χ2=4.110 0.053
? 微小钙化 196(67.1) 24(85.7) ? ?
? 非微小钙化(大钙化/无钙化) 96(32.9) 4(14.3) ? ?
纵横比 ? ? χ2=9.206 0.002
? >1 128(43.8) 4(14.3) ? ?
? ≤1 164(56.2) 24(85.7) ? ?
TI-RADS评估 ? ? χ2=25.033 <0.001
? 4a~4b PTCs 184(63.0) 4(14.3) ? ?
? 4c~5 PTCs 108(37.0) 24(85.7) ? ?
肿瘤大小 ? ? χ2=9.552 0.002
? >10 mm 120(41.1) 20(71.4) ? ?
? ≤10 mm 172(58.9) 8(28.6) ? ?
多灶性 92(31.5) 12(42.9) χ2=1.550 0.221
腺体外侵犯 54(74.0) 36(76.6) χ2=9.558 0.290
颈部淋巴结转移 104(35.6) 24(85.7) χ2=26.719 <0.001
手术方式 ? ? χ2=4.409 0.036
? 全切+颈部淋巴结清扫 148(50.7) 20(71.4) ? ?
? 次全切+颈部淋巴结清扫 144(49.3) 8(28.6) ? ?
表3 PTC复发的多因素Cox回归分析
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