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Analysis of risk factors for central lymph node metastasis in papillary thyroid microcarcinoma



Analysis of risk factors for central lymph node metastasis in papillary thyroid microcarcinoma



Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 54(1): 12-17



目的: 分析甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)患者中央区淋巴转移的危险因素。评估不同的危险因素预测PTMC患者颈部淋巴转移风险的可靠性,为PTMC行预防性中央区淋巴清扫提供临床支持依据。 方法: 回顾性分析四川省肿瘤医院2015年1月至2017年7月经外科治疗的700例甲状腺微小乳头状癌患者临床资料,所有患者均行一侧或双侧中央区淋巴清扫。将患者的基本信息、彩超信息、病理特征及淋巴转移情况进行单因素分析、多因素Logistic回归分析及受试者工作特征曲线(receiver operating characteristic curve,ROC)曲线分析,分析中央区淋巴转移的危险因素。 结果: 700例甲状腺微小乳头状癌患者中央区淋巴转移338例(48.29%)。多因素分析:年龄≤45岁、男性、多癌灶、癌灶侵及(出)被膜、癌灶钙化、肿瘤直径≥5 mm是PTMC中央区淋巴转移的独立危险因素。在中央区淋巴转移风险预测中,直径预测的最佳临界值是7 mm,ROC曲线下面积(area under the curve,AUC)为0.647;年龄预测的最佳临界值是41岁,ROC曲线AUC=0.597。单因素ROC曲线分析,性别因素ROC曲线AUC=0.588,癌灶数量因素ROC曲线AUC=0.627,肿瘤位置因素ROC曲线AUC=0.613,是否钙化因素ROC曲线AUC=0.603;根据年龄、性别、直径、位置、癌灶数量及钙化做多危险因素ROC曲线分析,AUC=0.768。 结论: 年龄≤45岁、男性、多癌灶、癌灶侵及(出)被膜、钙化、肿瘤直径≥5 mm是PTMC中央区淋巴转移的独立危险因素。当上述多个危险因素累积时,淋巴转移风险增高,应建议行中央区淋巴清扫。.

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Accession: 066446288

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PMID: 30704163


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