西安交通大学第一附属医院耳鼻咽喉头颈外科
Otorhinolaryngology Head and Neck Surgery Department of the First Affiliated Hospital of Xi’an Jiaotong University,Shannxi Xi’an,710061
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目的：探讨临床淋巴结阴性(clinical lymph node negative, cN0)甲状腺微小乳头状癌(papillarySthyroid microcarcinoma,PTMC)患者颈中央区淋巴结转移(central neck lymph node metastasis,CLNM)预测模型。方法：本研究纳入2015年~2020年在西安交通大学第一附属医院耳鼻咽喉头颈外科手术确诊的cN0-PTMC患者共1271例,根据手术记录和术后病理结果统计年龄、性别、肿瘤最大径、肿瘤位置、侧别、鼠类肉瘤滤过性毒菌致癌基因同源体B (v-raf murine sarcoma viral oncogene homolog B,BRAF)基因突变、伴发结节性甲状腺肿(nodular goiter,NG)和桥本氏甲状腺炎(Hashimoto"s thyroiditis, HT)情况、腺外侵犯、被膜侵犯、颈淋巴结转移等临床病理资料,分析CLNM与各临床病理参数的相关性。结果：采用年龄45岁作为分类标准进行单因素分析。结果显示男性、年龄≤45岁、肿瘤直径≤5mm、伴HT、多灶均与cN0-PTMC发生CLNM相关(P＜0.05)。合并NG、BRAFV600E基因突变、肿瘤位置、腺外侵犯、肿瘤侧、被膜侵犯均与cN0-PTMC发生CLNM无相关性(P＞0.05)。继续进行非条件Logistic回归分析,结果显示男性(OR=1.929,95%CI: 1.465~2.541)；≤45岁者(OR=2.581,95%CI: 2.004~3.324)；多灶(OR=1.675,95%CI: 1.276~2.197)cN0-PTMC患者发生CLNM的独立危险因素；直径≤5mm(OR=0.603,95%CI: 0.463~0.785)和伴HT(OR=0.642,95%CI: 0.452~0.913)是cN0-PTMC患者发生CLNM的保护因素。合并HT是cN0-PTMC患者BRAFV600E基因野生型的危险因素(OR=3.454,95%CI: 1.865~6.397)；结论：男性、≤45岁、＞5mm、不伴HT、多灶性是cN0-PTMC患者发生CLNM的独立危险因素。合并HT是此类患者发生BRAFV600E基因突变的保护因素,与其余临床病理特征无相关性。
Objective: To explore the predictive model of neck central lymph node metastasis in cN0-PTMC patients.SMethods: A total of 1271 cN0-PTMC patients diagnosed by the department of Otolaryngology and Head and Neck Surgery of the First Affiliated Hospital of Xi"an Jiaotong University from 2015 to 2020 were enrolled in this study. According to the surgical records and postoperative pathological results, the clinicopathological data such as age, sex, maximum tumor diameter, tumor location, lateral type, concomitant NG and HT, extraglandular invasion, capsule invasion and neck lymph node metastasis were calculated.SThe correlation between central lymph node metastasis and clinicopathological parameters was analyzed.SResults: the age of 45 years old was used as the classification standard for univariate analysis.SThe results showed that the incidence of CLNM in cN0-PTMC was associated with male, age≤ 45, tumor diameter ≤5mm, concomitant HT and multiple foci (P＜0.05). The incidence of CLNM in cN0-PTMC was not associated with concomitant NG, BRAFV600E gene mutation, tumor location, extraglandular invasion, lateral type and capsule invasion(P＞0.05).SThe categories of P＜0.05 in the univariate analysis were included in the unconditional Logistic regression equation, showed that the risk of CLNM in men with cN0-PTMC was 1.929 times higher than that in women (OR=1.929,95%CI: 1.465-2.541), and the risk of CLNM in patients less than 45 years old was 2.581 times higher than that in those over 45 years old (OR=2.581,95%CI: 2.004-3.324).SThe risk of CLNM in patients with multiple foci was 1.675 times higher than that in patients with single focus (OR=1.675,95%CI: 1.276-2.197), and the risk of CLNM was lower in patients with diameter ≤ 5mm (OR=0.603,95%CI: 0.463-0.785) and with HT (OR=0.642,95%CI: 0.452-0.913).SHT was the risk factor of wild type of BRAFV600E gene in cN0-PTMC patients (OR=3.454,95%CI: 1.865-6.397). Conclusion: male, ≤ 45 years old, > 5mm, without HT and multiple foci are independent risk factors for CLNM in cN0-PTMC patients.SHT is a protective factor for BRAFV600E gene mutation in these patients, and there is no correlation with other clinicopathological features.
