国际肿瘤学杂志

国际肿瘤学杂志 ›› 2018, Vol. 45 ›› Issue (7): 391-394.doi: 10.3760/cma.j.issn.1673-422X.2018.07.002

• 论著 • 上一篇    下一篇

甲状腺乳头状癌右侧喉返神经后方淋巴结转移的相关因素分析及其临床意义

陈宏存,李良,江鸣,张军,姚宝忠,姜友,廖理芳   

  1. 230000 合肥市第二人民医院普外科
  • 出版日期:2018-07-08 发布日期:2018-07-31
  • 通讯作者: 陈宏存，Email: chclm@sina.com E-mail:chclm@sina.com

Correlation analysis and clinical significance of lymph node metastasis in right recurrent laryngeal nerve of papillary thyroid carcinoma

Chen Hongcun, Li Liang, Jiang Ming, Zhang Jun, Yao Baozhong, Jiang You, Liao Lifang   

  1. Department of General Surgery, Second People′s Hospital of Hefei, Hefei 230000, China
  • Online:2018-07-08 Published:2018-07-31
  • Contact: Chen Hongcun, Email: chclm@sina.com E-mail:chclm@sina.com

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摘要： 目的  探讨甲状腺乳头状癌（PTC）右侧喉返神经深层淋巴结转移的相关因素及其临床意义。方法  对2015年1月至2017年8月在合肥市第二人民医院接受手术治疗的98例PTC患者的临床资料进行分析，将右侧中央区淋巴结以喉返神经为界，分为Ⅵ-A区（浅层）与Ⅵ-B区（深层，即喉返神经后方淋巴结），分析右侧中央区Ⅵ-B区淋巴结转移的影响因素。对右侧Ⅵ-A区淋巴结转移个数绘制受试者工作特征曲线（ROC），计算曲线下面积（AUC）及Youden指数。结果  98例患者中有16例发生右侧ⅥB区淋巴结转移（16.33%）。单因素分析结果显示，PTC患者Ⅵ-B区淋巴结转移与患者肿瘤大小（χ2=12.864，P＜0.001）、肿瘤包膜侵犯（χ2=16.354，P＜0.001）、右侧Ⅵ-A区淋巴结是否转移（χ2=16.065，P＜0.001）、肿瘤数量（χ2=15.593，P＜0.001）和颈侧区淋巴结转移（χ2=21.098，P＜0.001）相关，而与患者性别、年龄、病灶位置无关（均P＞0.05）。PTC患者Ⅵ-B区淋巴结转移与右侧Ⅵ-A区淋巴结转移个数相关，当右侧Ⅵ-A区淋巴结转移个数为2.5个时，其敏感性和特异性分别为70.60%、70.00%，AUC为0.754，Youden指数为0.406。结论  对于PTC患者，原发肿瘤直径＞1 cm、包膜侵犯、Ⅵ-A区淋巴结转移阳性、肿瘤多发、颈侧区淋巴结转移阳性均为Ⅵ-B区淋巴结转移的预测因素。当右侧Ⅵ-A区淋巴结转移个数≥3个时需行Ⅵ-B区淋巴结清扫。

关键词: 甲状腺肿瘤, 乳头状瘤, 淋巴转移, 右喉返神经后方淋巴结

Abstract: Objective  To explore the correlation factors and clinical significance of lymph node metastasis in right recurrent laryngeal nerve of thyroid papillary carcinoma (PTC). Methods  Ninty-eight consecutive patients with PTC who were underwent total thyroidectomy with routine central lymph node dissection in the Second People′s Hospital of Hefei from January 2015 to August 2017 were analyzed. The right paratracheal lymph nodes in the central compartment lymph nodes were divided into the  level Ⅵ-A (anterior) and level Ⅵ-B (posterior, that was lymph node posterior to recurrent laryngeal nerve) compartments by recurrent laryngeal nerve. The lymph node metastasis of Ⅵ-B area during central compartment lymph node dissection was analyzed. We drew the receiver-operating characteristic curve (ROC) for right neck Ⅵ-A number of lymph node metastasis, and calculated the area under the curve (AUC) and Youden index. Results  Among 98 cases, 16 cases occurred Ⅵ-B district lymph node metastasis (16.33%). Single factor analysis results showed that lymph node metastasis in Ⅵ-B area of PTC patients were related to the tumor size (χ2=12.864, P＜0.001), tumor capsular invasion (χ2=16.354, P＜0.001), the right neck Ⅵ-A area lymph node metastasis (χ2=16.065, P＜0.001), tumor number (χ2=15.593, P＜0.001) and neck lymph node metastasis  (χ2=21.098, P＜0.001), but they were not related to the patients′ gender, age and lesion location (all P＞0.05). Lymph node metastasis in Ⅵ-B area of PTC patients were related to the number of right neck Ⅵ-A area lymph node metastasis. When the number of right neck Ⅵ-A metastatic lymph nodes was 2.5, the sensitivity and specificity were 70.60% and 70.00% respectively, AUC was 0.754, and Youden index was 0.406. Conclusion  For patients with PTC, primary tumor diameter ＞1 cm, tumor extracapsular invasion, Ⅵ-A area lymph node metastasis, multiple tumor and lateral cervical lymph node metastasis were the predictive factors for the lymph node metastasis in Ⅵ-B area. When the number of right neck Ⅵ-A area metastatic lymph nodes was greater than 3, we should dissect Ⅵ-B area.

Key words: Thyroid neoplasms, Papilloma, Lymphatic metastasis, Lymph node posterior to right recurrent laryngeal nerve