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中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (06) : 570 -577. doi: 10.3877/cma.j.issn.1672-6448.2021.06.006

浅表器官超声影像学

甲状腺微小乳头状癌颈部淋巴结转移的相关危险因素
章美武1, 吕淑懿1, 范晓翔1, 庄鲁辉1, 裘玉琴1, 张燕1,()   
  1. 1. 315010 中国科学院大学宁波华美医院介入治疗科 中国科学院大学宁波生命与健康产业研究院
  • 收稿日期:2020-06-17 出版日期:2021-06-01
  • 通信作者: 张燕
  • 基金资助:
    宁波市科技惠民项目(2017C50070); 浙江省医药卫生科技计划项目(2020KY834)

Risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma

Meiwu Zhang1, Shuyi Lyu1, Xiaoxiang Fan1, Luhui Zhuang1, Yuqin Qiu1, Yan Zhang1()   

  1. 1. Department of Interventional Therapy, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo 315010, China
  • Received:2020-06-17 Published:2021-06-01
  • Corresponding author: Yan Zhang
引用本文:

章美武, 吕淑懿, 范晓翔, 庄鲁辉, 裘玉琴, 张燕. 甲状腺微小乳头状癌颈部淋巴结转移的相关危险因素[J/OL]. 中华医学超声杂志(电子版), 2021, 18(06): 570-577.

Meiwu Zhang, Shuyi Lyu, Xiaoxiang Fan, Luhui Zhuang, Yuqin Qiu, Yan Zhang. Risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(06): 570-577.

目的

探讨甲状腺微小乳头状癌(PTMC)颈部淋巴结转移及多个转移的相关危险因素。

方法

回顾性收集2016年1月至2019年12月在中国科学院大学宁波华美医院就诊,并行手术治疗的PTMC患者499例。记录患者性别、年龄等一般资料,PTMC原发灶超声特征、BRAF突变检测结果及手术病理结果等,淋巴结转移数量>5枚定义为淋巴结多个转移。采用单因素及多因素Logistic回归方法分析PTMC患者颈部淋巴结转移及多个转移的危险因素。

结果

颈部淋巴结转移率为41.9%(209/499),淋巴结多个转移率为7.4%(37/499)。Logistic回归分析显示,年龄<45岁(P=0.010,OR=1.663)、甲状腺球蛋白>7.89 ng/ml(P=0.017,OR=1.597)、结节≥7 mm(P=0.000,OR=2.120)、多发病灶(P=0.001,OR=2.052)、微钙化(P=0.028,OR=1.987)是颈部淋巴结转移的独立危险因素。209例PTMC淋巴结转移患者中,Logistic回归分析显示,结节≥7 mm(P=0.010,OR=3.227)、男性(P=0.039,OR=2.398)、多发病灶(P=0.006,OR=3.115)、被膜侵犯(P=0.032,OR=2.932)是颈部淋巴结多个转移的独立危险因素。

结论

PTMC患者有多个病灶、病灶直径≥7 mm,提示患者发生颈部淋巴结转移及多个转移的风险较高。术前超声评估为PTMC患者的临床治疗和预后评估提供了一定的参考依据。

Objective

To identify the risk factors for cervical lymph node metastasis and multiple metastases of papillary thyroid microcarcinoma (PTMC).

Methods

A total of 499 PTMC patients treated at Ningbo Hwa Mei Hospital of the University of Chinese Academy of Sciences from January 2016 to December 2019 were retrospectively collected. Patient gender, age, and other general information, ultrasound characteristics of the primary PTMC, BRAF mutation detection results, and surgical pathology results were recorded. The number of lymph node metastases >5 was defined as multiple lymph node metastases. Single factor and multivariate logistic analyses were used to identify the risk factors for cervical lymph node metastasis and multiple metastases in patients with PTMC.

Results

The cervical lymph node metastasis rate was 41.9% (209/499), and the multiple lymph node metastasis rate was 7.4% (37/499). Logistic multivariate analysis showed that age <45 years (P=0.010, odds ratio [OR]=1.663), thyroglobulin >7.89 ng/ml (P=0.017, OR=1.597), nodules ≥7 mm (P=0.000, OR=2.120), multiple foci (P=0.001, OR=2.052), and microcalcification (P=0.028, OR=1.987) were independent risk factors for lymph node metastasis. Among the 209 patients with PTMC lymph node metastasis, logistic multivariate analysis showed that nodules ≥7 mm (P=0.010, OR=3.227), male gender (P=0.039, OR=2.398), multiple foci (P=0.006, OR=3.115), and capsule invasion (P=0.032, OR=2.932) were independent risk factors for multiple lymph node metastases.

Conclusion

When patients with PTMC have multiple lesions and the lesion diameter is greater than or equal to 7 mm, they have a higher risk of cervical lymph node metastasis and multiple metastases. Preoperative ultrasound evaluation can provide an aid to the clinical treatment and prognosis evaluation of PTMC patients.

表1 甲状腺微小乳头状癌淋巴结转移的单因素分析
因素 淋巴结未转移(n=290) 淋巴结转移(n=209) 统计值 P
年龄(岁,
x¯
±s
46.3 ± 11.9 43.1 ± 12.5 t=2.899 0.004
BMI(kg/m2
x¯
±s
23.12 ± 3.02 23.30 ± 3.15 t=0.650 0.516
甲状腺球蛋白(ng/ml,
x¯
±s
11.13 ± 13.81 17.30 ± 33.05 t=2.543 0.012
TSH(mU/L,
x¯
±s
1.86 ± 1.48 1.71 ± 0.83 t=1.433 0.152
结节大小(mm,
x¯
±s
5.63 ± 2.00 6.58 ± 1.90 t=5.368 0.000
性别[例(%)] χ2=4.489 0.034

57(19.7) 58(27.8)

233(80.3) 151(72.2)
桥本甲状腺炎[例(%)] χ2=1.338 0.247

不伴桥本

234 (80.7) 177(84.7)

伴有桥本

56 (19.3) 32(15.3)
结节数量[例(%)] χ2=12.953 0.000

单灶

227(78.3) 133(63.6)

多灶

63(21.7) 76(36.4)
结节位置[例(%)] χ2=4.723 0.193

上极

70(24.1) 42(20.1)

中极

122(42.1) 80(38.3)

下极

73(25.2) 58(27.8)

峡部

25(8.6) 29(13.9)
结节形态[例(%)] χ2=0.303 0.582

规则

57 (19.7) 37(17.7)

不规则

233(80.3) 172(82.3)
边界[例(%)] χ2=1.328 0.249

62(21.4) 36(17.2)

欠清

228(78.6) 173(82.8)
回声强度[例(%)] χ2=0.163 0.686

低回声

260(89.7) 185(88.5)

非低回声

30(10.3) 24(11.5)
内部回声[例(%)] χ2=1.129 0.288

均匀

64(22.1) 38(18.2)

不均匀

226(77.9) 171(81.8)
纵横比[例(%)] χ2=5.019 0.025

<1

154(53.1) 132(63.2)

≥1

136(46.9) 77(36.8)
钙化[例(%)] χ2=13.945 0.000

无钙化

186(64.1) 99(47.4)

有钙化

104(35.9) 110(52.6)
钙化形态[例(%)] χ2=16.279 0.000

非微钙化

227(78.3) 129(61.7)

微钙化

63(21.7) 80(38.3)
内部血流[例(%)] χ2=1.791 0.181

166(57.2) 107(51.2)

124(42.8) 102(48.8)
被膜侵犯[例(%)] χ2=0.030 0.863

251(86.6) 182(87.1)

39(13.4) 27(12.9)
BRAF V600E突变[例(%)] χ2=4.478 0.034

野生型

87(30.0) 45(21.5)

突变型

203(70.0) 164(78.5)
表2 甲状腺微小乳头状癌淋巴结转移危险因素赋值表
表3 甲状腺微小乳头状癌淋巴结转移危险因素的Logistic多因素分析
表4 209例甲状腺微小乳头状癌淋巴结多个转移的单因素分析
因素 淋巴结转移数目 统计值 P
≤5个(n=172) >5个(n=37)
年龄(岁,
x¯
±s
43.3±12.6 42.0±12.0 t=0.602 0.548
BMI(kg/m2
x¯
±s
23.28±3.05 23.42±3.62 t=0.216 0.830
甲状腺球蛋白(ng/ml,
x¯
±s
15.82±26.40 24.20±54.22 t=0.918 0.162
TSH(mU/L,
x¯
±s
1.72±0.85 1.62±0.74 t=0.663 0.508
结节大小(mm,
x¯
±s
6.38±1.86 7.51±1.84 t=3.365 0.001
性别[例(%)] χ2=3.678 0.050

43(25.0) 15(40.5)

129(75.0) 22(59.5)
桥本甲状腺炎[例(%)] χ2=0.112 0.738

不伴桥本

145(84.3) 32(86.5)

伴有桥本

27(15.7) 5(13.5)
结节数量[例(%)] χ2=4.364 0.037

单灶

115(66.9) 18(48.6)

多灶

57(33.1) 19(51.4)
结节位置[例(%)] χ2=2.909 0.406

上极

32(18.6) 10(27.0)

中极

68(39.5) 12(32.4)

下极

46(26.7) 12(32.4)

峡部

26(15.1) 3(8.1)
结节形态[例(%)] χ2=2.683 0.101

规则

27(15.7) 10(27.0)

不规则

145(84.3) 27(73.0)
边界[例(%)] χ2=0.032 0.858

30(17.4) 6(16.2)

欠清

142(82.6) 31(83.8)
回声强度[例(%)] χ2=1.634 0.201

低回声

150(87.2) 35(94.6)

非低回声

22(12.8) 2(5.4)
内部回声[例(%)] χ2=0.358 0.550

均匀

30(17.4) 8(21.6)

不均匀

142(82.6) 29(78.4)
纵横比[例(%)] χ2=3.028 0.082

<1

104(60.5) 28(75.7)

≥1

68(39.5) 9(24.3)
钙化[例(%)] χ2=5.611 0.018

无钙化

88(51.2) 11(29.7)

有钙化

84(48.8) 26(70.3)
钙化形态[例(%)] χ2=3.253 0.071

非微钙化

111(64.5) 18(48.6)

微钙化

61(35.5) 19(51.4)
内部血流[例(%)] χ2=0.000 0.983

88(51.2) 19(51.4)

84(48.8) 18(48.6)
被膜侵犯[例(%)] χ2=4.504 0.031

154(89.5) 28(75.7)

18(10.5) 9(24.3)
BRAF V600E突变[例(%)] χ2=1.789 0.181

野生型

34(19.8) 11(29.7)

突变型

138(80.2) 26(70.3)
表5 甲状腺微小乳头状癌淋巴结多个转移危险因素赋值表
表6 甲状腺微小乳头状癌淋巴结多个转移危险因素的Logistic回归分析
1
Haugen BR. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: what is new and what has changed? [J]. Cancer, 2017, 123(3): 372-381.
2
Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer [J]. Thyroid, 2009, 19(11): 1167-1214.
3
Cho SY, Lee TH, Ku YH, et al. Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia [J]. Surgery, 2015, 157(1): 111-118.
4
Lerner J, Goldfarb M. Pediatric thyroid microcarcinoma [J]. Ann Surg Oncol, 2015, 22(13): 4187-4192.
5
Ito Y, Miyauchi A, Kihara M, et al. Patient age is signify-cantly related to the progression of papillary microcarcinoma of the thyroid under observation [J]. Thyroid, 2014, 24(1): 27-34.
6
Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer [J]. Thyroid, 2016, 26(1):1-133.
7
Adam MA, Pura J, Goffredo P, et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer [J]. J Clin Oncol, 2015, 33(21): 2370-2375.
8
中国抗癌协会甲状腺癌专业委员会. 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版) [J]. 中国肿瘤临床, 2016, 43(10): 405-411.
9
Creach KM, Gillanders WE, Siegel BA, et al. Management of cervical nodal metastasis detected on Ⅰ-131 scintigraphy after initial surgery of well-differentiated thyroid caicinoma [J]. Surgery, 2010, 148(6): 1198-1204.
10
Sipos JA. Advances in ultrasound for the diagnosis and management of thyroid cancer [J]. Thyroid, 2009, 19(12): 1363-1372.
11
Erdem H, Gundogdu C, Sipal S. Correlation of E-cadherin, VEGF, COX-2 expression to prognostic parameters in papillary thyroid carcinoma [J]. Exp Mol Pathol, 2011, 90(3): 312-317.
12
Randolph GW, Duh QY, Heller KS, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension [J]. Thyroid, 2012, 22(11): 1144-1152.
13
汤靖岚, 侯春杰, 范小明. 甲状腺微小乳头状癌中央区淋巴结转移的术前超声预测模型建立 [J/CD]. 中华医学超声杂志(电子版), 2019, 16(4): 257-263.
14
Gui CY, Qiu SL, Peng ZH, et al. Clinical and pathologic predictors of central lymph node metastasis in papillary thyroid microcarcinoma: a retrospective cohort study [J]. J Endocrinol Invest, 2018, 41(4): 403-409.
15
叶添添, 夏宇, 姜玉新, 等. 甲状腺微小乳头状癌原发病变超声特点与颈部大量淋巴结转移的相关性 [J/CD]. 中华医学超声杂志(电子版), 2017, 14(10): 760-765.
16
张于芝, 丁文波, 武心萍, 等. 临床超声及细胞病理学特征对甲状腺微小乳头状癌中央区淋巴结转移的预测价值 [J]. 中国超声医学杂志, 2017, 33(11): 964-967.
17
樊秋兰, 陈霰, 于春洋, 等. 普通超声及超声造影预测甲状腺微小乳头状癌中央区淋巴结转移的价值 [J]. 中国超声医学杂志, 2016, 32(12): 1060-1062.
18
张剑, 王跃涛, 徐斌, 等. 甲状腺微小乳头状癌原发灶超声特征与颈部淋巴结转移的关系 [J]. 中国医学影像学杂志, 2016, 24(8): 573-577.
19
曾书娥, 于姣姣, 耿霞飞. 甲状腺微小乳头状癌的超声特征与中央区淋巴结转移的危险因素分析 [J]. 中国中西医结合影像学杂志, 2019, 17(5): 497-499.
20
Yang Y, Chen C, Chen Z, et al. Prediction of central compartment lymph node metastasis in papillary thyroid microcarcinoma [J]. Clin Endocrinol (Oxf), 2014, 81(2): 282-288.
21
张磊, 杨进宝, 孙庆贺, 等. cN0甲状腺微小乳头状癌多个淋巴结转移的危险因素分析 [J]. 中国肿瘤临床, 2017, 44(16): 805-809.
22
姜波, 罗渝昆, 张艳, 等. 甲状腺乳头状癌的常规超声及超声造影特征与淋巴结转移的相关性 [J]. 首都医科大学学报, 2019, 40(6): 818-823.
23
王文涵, 詹维伟, 徐上妍, 等. 甲状腺微小乳头状癌的超声特征与颈部淋巴结转移的关系 [J]. 中华超声影像学杂志, 2014, 23(3): 231-234.
24
Xing M, Alzahrani , Carson KA, et al. Association between BRAF V600E mutation and recurrence of papillary thyroid cancer [J]. J Clin Oncol, 2015, 33(1): 42-50.
25
Chakraborty A, Narkar A, Mukhopadhyaya R, et al. BRAF V600E mutation in papillary thyroid carcinoma: significant association with node metastases and extra thyroidal invasion [J]. Endocr Pathol, 2012, 23(2): 83-93.
26
Lee YK, Park KH, Park SH, et al. Association between diffuse lymphocytic infiltration and papillary thyroid cancer aggressiveness according to the presence of thyroid peroxidase antibody and BRAFV600E mutation [J]. Head Neck, 2018, 40(10): 2271-2279.
27
Walts AE, Mirocha JM, Bose S. Follicular variant of papillary thyroid carcinoma (FVPTC): histological features, BRAF V600E mutation, and lymph node status [J]. J Cancer Res Clin Oncol, 2015, 141(10): 1749-1756.
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