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目的:探讨1988例甲状腺微小乳头状癌(PTMC)颈部中央区淋巴结转移的危险因素。方法:回顾性分析新疆医科大学附属肿瘤医院2010-01-2016-03期间初治的PTMC癌患者的临床病理特征,通过χ~2检验、多因素统计分析,探讨颈部中央区淋巴结转移的危险因素。结果:颈部中央区淋巴结转移率为34.9%。单因素分析显示,确诊年龄<45岁、男性、多灶、肿瘤位于双侧腺叶(含峡部)、肿瘤直径>5mm、包膜浸润、包膜外侵犯是颈部中央区淋巴结转移的危险因素(P<0.05);多因素分析显示,男性、确诊年龄<45岁、肿瘤直径>5mm、包膜浸润、包膜外侵犯是影响颈部中央区淋巴结转移的独立危险因素。肿瘤位置是单灶颈部中央区淋巴结转移的独立危险因素,其中单灶位于腺叶下极者中央区淋巴结转移率最高(46.8%);而多灶肿瘤位置与中央区淋巴结转移无关(P>0.05)。结论:当PTMC患者存在以下情况:男性、确诊年龄<45岁、肿瘤直径>5mm、包膜浸润、包膜外侵犯,单灶位于腺叶下极时,应警惕淋巴结转移可能,建议行积极诊治方案以及更加密切的术后随访。
Objective: To investigate the risk factors of lymphatic metastasis in 1988 cervical papillary thyroid carcinoma (PTMC). Methods: The clinicopathological features of patients with newly diagnosed PTMC cancer from Cancer Hospital of Xinjiang Medical University from January 2010 to March 2016 were retrospectively analyzed. The risk of lymph node metastasis in the central region of the neck was investigated by χ ~ 2 test and multivariate statistical analysis factor. Results: The central lymph node metastasis rate was 34.9%. Univariate analysis showed that the diagnosis of age <45 years old, male, multifocal tumor located in the bilateral lobes (including isthmus), tumor diameter> 5mm, envelope invasion, extracapsular invasion is the central neck lymph node metastasis risk factors (P <0.05). Multivariate analysis showed that men, age of diagnosis <45 years, tumor diameter> 5mm, invasion of the capsule and extracapsular invasion were independent risk factors for cervical lymph node metastasis. The location of tumor was an independent risk factor of lymph node metastasis in the central region of single neck. Among them, the single lymph node metastasis rate was the highest in the central region of the inferior gland lobes (46.8%); however, the location of multifocal tumor was not related to the central lymph node metastasis (P> 0.05). CONCLUSION: Patients with PTMC should be alert for lymph node metastasis if they have the following conditions: male, age at diagnosis <45 years, diameter of tumor> 5 mm, capsule invasion, extracapsular invasion. Programs and closer postoperative follow-up.