本文選題：甲狀腺微小乳頭狀癌　切入點(diǎn)：中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移　出處：《新疆醫(yī)科大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:探討甲狀腺微小乳頭狀癌(papillary thyroid microcarcinoma,PTMC)臨床病理特征及中央?yún)^(qū)淋巴結(jié)轉(zhuǎn)移(the central lymph node metastasis,CLNM)風(fēng)險(xiǎn)因素;尤其探討不同確診年齡截點(diǎn)與CLNM相關(guān)性,闡述年齡意義;對(duì)比腫瘤最大經(jīng)(the primary tumor diameter,PTD)、癌灶總直徑(the total tumor diameter,TTD)與CLNM危險(xiǎn)因素研究結(jié)果,闡述TTD衡量多灶PTMC大小合理性。方法:回顧性分析新疆醫(yī)科大學(xué)附屬腫瘤醫(yī)院2010年1月至2016年3月初治的PTMC患者臨床病理特征,通過(guò)X2檢驗(yàn)、ROC曲線(xiàn)及多因素統(tǒng)計(jì)分析,探討CLNM風(fēng)險(xiǎn)因素。結(jié)果:CLNM率為34.9%。多因素分析顯示,男性、確診年齡45歲、腫瘤數(shù)目≥3個(gè)、腫瘤直徑5mm、伴微小或伴微小+粗大鈣化、包膜浸潤(rùn)、不伴甲炎、不伴結(jié)節(jié)性甲狀腺腫是影響CLNM獨(dú)立危險(xiǎn)因素(均P0.05);而腫瘤位置、包膜外侵犯、伴粗大鈣化與CLNM差異無(wú)統(tǒng)計(jì)學(xué)意義。除70歲截點(diǎn)外,25~70歲年齡區(qū)間中每5歲為截點(diǎn)及30~60歲年齡區(qū)間中每歲為截點(diǎn)均有統(tǒng)計(jì)學(xué)差異,即上述確診年齡截點(diǎn)均可提示確診年齡是CLNM獨(dú)立危險(xiǎn)因素。與PTD相比,將TTD作為多灶PTMC大小,更能表明腫瘤直徑與CLNM相關(guān)性及變化趨勢(shì)。腫瘤位置是單灶CLNM獨(dú)立危險(xiǎn)因素,當(dāng)其位于下極,CLNM率最高;而多灶腫瘤位置與CLNM無(wú)關(guān)(P=0.211)。結(jié)論:當(dāng)PTMC存在以下情況,如:男性、數(shù)目≥3個(gè)、腫瘤直徑5mm、伴有微小或伴有微小+粗大鈣化、包膜浸潤(rùn)、不伴有結(jié)節(jié)性甲狀腺腫、不伴有甲炎、單灶位于下極,應(yīng)警惕CLNM可能。其次,年齡僅代表變化趨勢(shì),無(wú)確定截點(diǎn);將年齡看成連續(xù)型變量,在相關(guān)研究結(jié)果闡述中更加合理。與PTD相比,TTD是多灶PTMC真正大小。
[Abstract]:Objective: to investigate the clinicopathological features of papillary thyroid microcarcinoma of thyroid micropapillary carcinoma and the risk factors of central lymph node metastasis of the central lymph nodes, especially to explore the correlation between different diagnostic age points and CLNM, and to elucidate the significance of age. Compared with the study of the primary tumor diameterus, the total diameter of the tumor focus and the total tumor diameterus, the results of the study on the risk factors of CLNM were compared. Methods: the clinicopathological characteristics of PTMC patients treated from January 2010 to early March 2016 in affiliated Cancer Hospital of Xinjiang Medical University were analyzed retrospectively. The multivariate analysis showed that the age of diagnosis was 45 years old, the number of tumors was more than 3, the diameter of the tumor was 5 mm, the diameter of the tumor was 5 mm, with small or small calcification, capsule infiltration, no thyroiditis. No nodular goiter was an independent risk factor for CLNM (all P 0.05), and tumor location, extracapsular invasion. There was no significant difference between coarse calcification and CLNM. There were significant differences in the cut-off points of 2570 years old and 30 ~ 60 years old except for 25 ~ 70 years old and 30 ~ 60 years old. Compared with PTD, using TTD as the size of multi-focus PTMC can better indicate the correlation between tumor diameter and CLNM, and the location of tumor is an independent risk factor for single focus CLNM, which indicates that the age of diagnosis is an independent risk factor for CLNM. When the tumor was located at the lower pole, the rate of CLNM was the highest, and the location of multi-focus tumor was not related to CLNM. Conclusion: when PTMC exists, for example, male, the number is more than 3, the diameter of tumor is 5 mm, with small or small coarse calcification and capsule infiltration. There is no nodular goiter, no thyroiditis, single focus is at the lower pole, we should be aware of the possibility of CLNM. Secondly, age only represents the trend of change, there is no definite cut-off point; the age is regarded as a continuous variable. Compared with PTD, TTD is the real size of multifocal PTMC.
【學(xué)位授予單位】：新疆醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R736.1

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1 李耀;Galectin-3、CK19、MC在不同危險(xiǎn)度分層的PTMC表達(dá)與意義[D];福建醫(yī)科大學(xué);2016年

2 李曉京;1988例甲狀腺微小乳頭狀癌（PTMC）臨床病理特征及頸部中央?yún)^(qū)淋巴結(jié)危險(xiǎn)因素分析[D];新疆醫(yī)科大學(xué);2017年

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本文編號(hào)：1593195