朱敏,苗玉堂,赛力克·马高维亚,吾甫尔·依马尔,王护国
ZHU Min,MIAO Yu-tang,Sailike MAGAOWEIYA,Wufuer YIMAER,WANG Hu-guo

• 1:新疆医科大学第一附属医院血管甲状腺外科

摘要(Abstract)：

目的探讨多发癌灶对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)临床病理特征及中央区淋巴结转移的影响。方法 PTC患者838例,根据癌灶数目是否≥2个分为多灶组283例和单灶组555例,比较2组临床和病理资料,分析多灶组发生中央区淋巴结转移与临床病理特征间的关系,采用多因素logistic回归分析多灶性PTC发生中央区淋巴结转移的危险因素。结果多灶组患者年龄、性别比例、术前促甲状腺激素释放激素水平、肿瘤最大径及腺外侵犯比率、伴有钙化灶比率与单灶组比较差异无统计学意义(P>0.05),多灶组患者体质量指数[(25.25±4.18)kg/cm2]、癌结节形态不规则比率(85.5%)、边界不清比率(84.1%)、含微小癌灶比率(68.2%)、合并桥本氏甲状腺炎(Hashimoto's thyroiditis,HT)比率(32.2%)、双侧癌发生率(79.9%)、总淋巴结转移率(54.8%)、中央区淋巴结转移率(54.8%)、TNM分期Ⅲ期比率(17.7%)和Ⅳ期比率(6.7%)均高于单灶组[(24.40±3.43)kg/cm2、79.1%、75.5%、58.9%、19.8%、0、35.7%、33.0%、10.3%、4.5%](P<0.05);多灶组发生中央区淋巴结转移者肿瘤最大径[(1.23±1.16)cm]及合并HT发生率(67.0%)高于无中央区淋巴结转移者[(0.89±0.09)cm、33.0%](P<0.05);肿瘤最大径增大(OR=1.959,95%CI:1.135~3.379,P=0.016)和合并HT(OR=2.072,95%CI:1.214~3.536,P=0.008)是多灶性PTC发生中央区淋巴结转移的独立危险因素。结论多灶性PTC多见于双侧甲状腺,常含有微小癌灶,易合并HT及中央区淋巴结转移;肿瘤最大径增大和合并HT是多灶性PTC发生中央区淋巴结转移的独立危险因素。
Objective To investigate the influence of multifocal papillary thyroid carcinoma(PTC)on clinicopathological features and central lymph node metastasis.Methods A total of 838 patients with PTC were divided into multifocal group(≥ 2 foci,n=283)and solitary group(n=555)according to the foci number.The clinical and pathological data were compared between two groups.The relationship between central lymph node metastasis and clinical pathological features was analyzed in multifocal group.Multivariate logistic regression was used to analyze the risk factors for central lymph node metastasis in multifocal PTC.Results There were no significant differences in the age,gender,thyroid stimulating hormone level,maximum tumor diameter,tumor invasion proceeding beyond the thyroid or not,and complicated with or with not calcification between multifocal group and solitary group(P>0.05).The body mass index((25.25±4.18)kg/cm2),and rates of irregular carcinoma nodules(85.5%),unclear boundary(84.1%),minimal carcinoma foci(68.2%),Hashimoto's thyroiditis(32.2%),bilateral thyroid carcinoma(79.9%),total lymph node metastasis(54.8%),central lymph node metastasis(54.8%),TNM stageⅢ(17.7%)and stageⅣ(6.7%)in multifocal group were significantly higher than those in solitary group((24.40±3.43)kg/cm2,79.1%,75.5%,58.9%,19.8%,0,35.7%,33.0%,10.3%,4.5%)(P<0.05).The maximum tumor diameter was significantly longer and the incidence of Hashimoto's thyroiditis was significantly higher in patients with central lymph node metastasis((1.23±1.16)cm,67.0%)than those in patients with no central lymph node metastasis((0.89±0.69)cm,33.0%)in multifocal group(P<0.05).The increased maximum tumor diameter(OR=1.959,95%CI:1.135-3.379,P=0.016)and incidence of Hashimoto's thyroiditis(OR=2.072,95%CI:1.214-3.536,P=0.008)were the independent risk factors for central lymph node metastasis in multifocal group.Conclusion Multifocal PTC is more common in bilateral thyroid,containing minimal cancer foci,and is easily complicated with Hashimoto's thyroiditis and central cervical lymph node metastasis.The increased maximum tumor diameter and complication of Hashimoto's thyroiditis are the independent risk factors for central lymph node metastasis in multifocal PTC.

关键词(KeyWords)： 甲状腺乳头状癌;多灶性;中央区淋巴结;淋巴结转移;危险因素
Papillary thyroid carcinoma;multifocal;central lymph mode;lymph node metastasis;risk factor

Abstract:

Keywords:

基金项目(Foundation): 新疆维吾尔自治区自然科学基金(2016D01C298)

作者(Author): 朱敏,苗玉堂,赛力克·马高维亚,吾甫尔·依马尔,王护国
ZHU Min,MIAO Yu-tang,Sailike MAGAOWEIYA,Wufuer YIMAER,WANG Hu-guo

参考文献(References)：

• [1]IACOBONE M,JANSSON S,BARCZYNSKI M,et al.Multifocal papillary thyroid carcinoma:a consensus report of the European Society of Endocrine Surgeons(ESES)[J].Langenbecks Arch Surg,2014,399(2):141-154.
• [2]TUTTLE R M,HADDAD R I,BALL D W,et al.Thyroid carcinoma,version 2.2014[J].Natl Compr Canc Netw,2014,12(12):1671-1680.
• [3]KIM H J,SOHN S Y,JANG H W,et al.Multifocality,but not bilaterality,is a predictor of disease recurrence/persistence of papillary thyroid carcinoma[J].World J Surg,2013,37(2):376-384.
• [4]林琳,郑向前,刘磊,等.多灶性甲状腺乳头状癌的生物学特性及治疗分析[J].中华普通外科杂志,2010,25(8):621-623.
• [5]陈诚,余宁康,陈曦,等.重视甲状腺多灶癌的诊断和规范治疗[J].上海医药,2012,33(18):6-8.
• [6]孟庆东,边学海,孙辉.多灶性甲状腺乳头状癌的诊疗进展[J].中国普通外科杂志,2016,25(11):1640-1645.
• [7]SHAN Z D,GONG P,WANG Z Y.Change of constituent ratio and clinical analysis of multifocal papillary thyroid carcinoma[J].Int J Surg,2013,40(5):306-310.
• [8]KIRIAKOPOULOS A,PETRALIAS A,LINOS D.Multifocal versus solitary papillary thyroid carcinoma[J].World J Surg,2016,40(9):1-5.
• [9]BHASKARAN K,DOUGLAS I,FORBES H,et al.Body mass index and risk of 22specific cancers:apopulation-based cohort study of 5.24million UK adults[J].Lancet,2014,384(9945):755-765.
• [10]周晓倩,金慧,郑淼,等.合并桥本甲状腺炎的甲状腺乳头状癌术式探讨[J].中华普通外科杂志,2016,31(3):236-237.
• [11]林益凯,盛建明,赵文和,等.多灶性甲状腺乳头状癌168例临床研究[J].中华外科杂志,2009,47(6):450-453.
• [12]郑向前,夏婷婷,林琳,等.多灶性甲状腺乳头状癌BRAFv600E基因突变及临床生物学特性分析[J].中国肿瘤临床,2011,38(21):1326-1329.
• [13]王建红,王正滨,房世保,等.桥本甲状腺炎合并多灶性甲状腺乳头状癌的超声诊断价值[J].中华医学超声杂志,2013,10(7):596-598.
• [14]矫杰,周迎生,陈宝玥,等.甲状腺结节伴乳头状癌临床特征及恶性风险因素分析[J].中华实用诊断与治疗杂志,2015,29(1):53-55.
• [15]TAM A A,ZDEMIR D,UHACI N,et al.Association of multifocality,tumor number,and total tumor diameter with clinicopathological features in papillary thyroid cancer[J].Endocrine,2016,53(3):774-783.
• [16]QU N,ZHANG L,WU W L,et al.Bilaterality weighs more than unilateral multifocality in predicting prognosis in papillary thyroid cancer[J].Tumor Biol,2016,37(7):8783-8789.
• [17]WANG Q,CHU B,ZHU J,et al.Clinical analysis of prophylactic central neck dissection for papillary thyroid carcinoma[J].Clin Transl Oncol,2014,16(1):44-48.
• [18]李镜发,邹德环,佘立群,等.甲状腺癌术后大剂量131I治疗疗效分析[J].中华实用诊断与治疗杂志,2013,27(2):129-130.
• [19]杜军威,邱新光.分化型甲状腺癌术后复发研究新进展[J].医药论坛杂志,2014,35(1):141-143.