本文選題：甲狀腺微小乳頭狀癌　切入點：cN　出處：《中國腫瘤臨床》2017年16期

【摘要】：目的:術(shù)后病理證實的淋巴結(jié)轉(zhuǎn)移在臨床淋巴結(jié)轉(zhuǎn)移陰性(clinical lymph node negative,cN0)的甲狀腺乳頭狀癌(papillary thyroid carcinoma,PTC)中并不罕見,本研究旨在探討臨床淋巴結(jié)轉(zhuǎn)移陰性的甲狀腺微小乳頭狀癌(papillary thyroid microcarcinoma,PTMC)淋巴結(jié)轉(zhuǎn)移的危險因素,特別是多個淋巴結(jié)轉(zhuǎn)移(5枚)的危險因素。方法:回顧性分析中國醫(yī)學科學院北京協(xié)和醫(yī)院2013年11月至2014年10月行手術(shù)的cN0 PTMC患者1 268例,其中男性270例,女性998例。分析患者的臨床病理學特征,通過單因素、多因素分析尋找淋巴結(jié)轉(zhuǎn)移及多個轉(zhuǎn)移的風險因素。結(jié)果:1 268例患者中共出現(xiàn)淋巴結(jié)轉(zhuǎn)移416例(32.8%),多個淋巴結(jié)轉(zhuǎn)移43例(3.4%),淋巴結(jié)轉(zhuǎn)移的危險因素的單因素分析中,男性(42.22%vs.30.26%,P0.01)、年齡40歲(40歲為48.39%,40~59歲為27.62%,年齡≥60歲為22.45%,P0.03)、多發(fā)病灶(41.00%vs.29.03%,P0.01)、無慢性淋巴細胞性甲狀腺炎(36.44%vs.20.62%,P0.01)、腫瘤直徑0.5 cm(35.77%vs.23.05%,P0.01)者淋巴結(jié)轉(zhuǎn)移比例顯著增加。多因素分析中,男性(OR=1.516,P0.001)、多發(fā)病灶(OR=1.743,P0.001)、腫瘤直徑0.5 cm(OR=1.788,P0.001)是淋巴結(jié)轉(zhuǎn)移的獨立危險因素;而年齡較大患者(40~59歲OR=0.388;60歲及以上OR=0.301,P0.001)、慢性淋巴細胞性甲狀腺炎(OR=0.472,P0.001)是出現(xiàn)淋巴結(jié)轉(zhuǎn)移的保護性因素。在多個淋巴結(jié)轉(zhuǎn)移危險因素的多因素分析中,男性(OR=2.383,P=0.002)是多個淋巴結(jié)轉(zhuǎn)移的獨立危險因素;而年齡≥40歲則是保護性因素(OR=0.270,P0.001)。結(jié)論:cN0 PTMC淋巴結(jié)轉(zhuǎn)移并不少見,但是多個淋巴結(jié)轉(zhuǎn)移少見,男性、年齡40歲的患者淋巴結(jié)轉(zhuǎn)移、多個轉(zhuǎn)移的風險明顯增加。
[Abstract]:Objective: postoperative pathologically confirmed lymph node metastasis is not uncommon in papillary thyroid carcinoma of thyroid gland with clinical lymph node metastasis negative lymph node negativecN0.The aim of this study was to investigate the risk factors of papillary thyroid micrometastasis, especially 5 lymph node metastases, in papillary thyroid microcarcinoma of thyroid micropapillary carcinoma with negative lymph node metastasis.Methods: a total of 1 268 cN0 PTMC patients, including 270 males and 998 females, underwent surgery in Peking Union Hospital of the Chinese Academy of Medical Sciences from November 2013 to October 2014 were retrospectively analyzed.The clinicopathological features of the patients were analyzed and the risk factors of lymph node metastasis and multiple metastasis were analyzed by univariate and multivariate analysis.Results there were 416 cases with lymph node metastasis in 1 268 cases, 43 cases with multiple lymph node metastasis, and 3.4 cases with multiple lymph node metastasis. The risk factors of lymph node metastasis were analyzed.In multivariate analysis of risk factors for multiple lymph node metastasis, male ORA 2.383 P0. 002) was an independent risk factor for multiple lymph node metastasis, while age 鈮，

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