甲状腺乳头状癌中央区淋巴结转移的相关临床因素分析

Analysis of Clinical Factors Related to Central Lymph Node Metastasis in Papillary Thyroid Carcinoma

摘要: 目的：分析不同因素对甲状腺乳头状癌患者中央区淋巴结转移的影响，从而帮助医生们能从多角度分析，成为术中是否行中央区淋巴结清扫的依据。方法：收集2022年6月至2024年2月就诊于安徽医科大学第二附属医院的甲状腺乳头状癌患者，共76例，收集一般资料，包括：性别、年龄；肿瘤相关特征包括：肿瘤双侧性、是否多发病灶、肿瘤大小、与被膜距离关系、BRAF基因突变情况；超声检查结果包括：肿瘤位置、纵横比、有无血流通过、钙化情况。应用SPSS软件(版本25.0)对收集数据进统计学分析，中央区淋巴结转移阳性组和阴性组的组间比较，分类资料使用卡方检验，计量资料比较采用t检验，方差不齐时采用秩和检验。采用多因素Logistic回归分析法进行中央区淋巴结转移相关临床危险因素的分析。结果：单因素回归分析提示：在甲状腺乳头状癌中央区淋巴结转移组与未转移组间肿瘤大小、原发肿瘤为单发或多发、是否伴钙化总体分布均存在显著性差异(p < 0.05)，有统计学意义。而年龄、性别、双侧性、肿瘤与被膜间距离、BRAF基因是否突变、肿瘤位置、有无血流通过在两组间无显著性差异(p > 0.05)，无统计学意义。对因素进行多因素Logistic回归分析，变量进入方法为逐步进入法，得出肿瘤大小具有显著性差异(p < 0.05)，是影响中央区淋巴结转移的独立因素。根据OR值可知，肿瘤越大的患者出现中央区淋巴结转移的可能性更高。结论：术前超声检查提示甲状腺乳头状癌直径大、多发、伴有钙化的发生中央区淋巴结转移可能性较大，对术前超声未提示中央区淋巴结转移患者，术中是否行预防性颈部淋巴结清扫有着借鉴作用，从而减小甲状腺乳头状癌患者术后复发可能，改善部分患者由于复发所致生存质量及生存时间的降低，对患者术后生活质量提高有着积极意义，所以，术前进行良好的颈部淋巴结转移评估有着极其重要的临床意义。

Abstract: Objective: To analyze the effects of different factors on central lymph node metastasis in patients with papillary thyroid carcinoma, so as to help doctors analyze whether to perform intraoperative central lymph node exploration and dissection from multiple perspectives. Methods: A total of 76 patients with thyroid nodules who were admitted to the Second Affiliated Hospital of Anhui Medical University from June 2022 to February 2024 were selected, and general data, including gender and age, were collected. Tumor-related characteristics, including bilateral tumor, multiple lesions, tu-mor size, distance from the capsule, BRAF gene mutations; ultrasonography findings, including tu-mor location, aspect ratio, presence or absence of blood flow, and calcifications. SPSS software (ver-sion 25.0) was used for statistical analysis of the collected data, and the group was compared be-tween the positive and negative groups for central lymph node metastasis, and the chi-square test was used for categorical data, the t-test was used for continuous data comparison, and the rank-sum test was used for irregular variance. Multivariate Logistic regression analysis was used to analyze the clinical risk factors related to lymph node metastasis in the central region. Results: Univariate regression analysis showed that there were significant differences in tumor size, single or multiple primary tumors, and whether there was calcification between the central lymph node metastasis group and the non-metastasis group of papillary thyroid carcinoma (p < 0.05). There were no sig-nificant differences in age, gender, bilaterality, distance from the capsule, BRAF gene mutation, tu-mor location, and blood flow between the two groups (p > 0.05) with statistical significance. Multi-variate Logistic regression analysis was performed, and the variable entry method was stepwise entry method, and it was concluded that there was a significant difference in tumor size (p < 0.05), without statistical significance, which was an independent factor affecting lymph node metastasis in the central region. Based on the OR value, patients with larger ultrasound aspect ratios are more likely to have central lymph node metastases. Conclusions: Preoperative ultrasound examination showed that the thyroid tumor was larger, more frequent and with calcification, and the central lymph node metastasis was more likely, which has a positive significance for the improvement of postoperative quality of life for patients with no central lymph node malignancy in preoperative ul-trasound, so as to reduce the potential recurrence of papillary thyroid carcinoma patients after surgery, improve the quality of life and the reduction of survival time due to recurrence in some pa-tients, and improve the postoperative quality of life of patients. A good preoperative assessment of cervical lymph node metastases is of great clinical significance.