Correlation between preoperative serum thyroid stimulating hormone and cN0 lymph node metastasis in unilateral central region of thyroid micropapillary carcinoma / 国际外科学杂志

ABSTRACT

Objective:To investigate the correlation between preoperative thyroid function and central lymph node metastasis in cN0 unilateral papillary thyroid microcarcinoma (PTMC).Methods:The clinical data of 208 patients with cN0 unilateral PTMC admitted to the First Affiliated Hospital of Anhui University of Science and Technology from July 2020 to December 2021 were retrospectively analyzed. The patients were divided into a metastasis group( n=64) and a non-metastasis group( n=144) according to whether there was central lymph node metastasis in postoperative pathology. The preoperative serum free three iodine thyroid gland (FT3), free thyroid hormone (FT4), thyroid stimulating hormone (TSH), anti thyroid peroxidase antibody (TPOAb) , anti thyroid globulin antibody (TGAb), paraffin pathological results and general data were compared between the two groups of patients. Statistical analysis was performed using SPSS 19.0 software. The measurement data of normal distribution were expressed by Mean±SD , and comparison between groups was performed by t test. Non-normal distribution measurement data were expressed as [ M( Q1, Q3)], and comparison between groups was performed by Mann-Whitney U test. Enumeration data were represented by n(%), and comparison between groups was performed by chi-square. Multivariate analysis was conducted by binary logistic multivariate regression analysis. Results:In 208 PTMC patients with cN0, the rate of central lymph node metastasis was 30.77% (64/208). The misexcision rate of parathyroid gland was 28.13% (18/64) in the metastatic group, 25.69% (37/144) in the non-metastatic group, and the overall misexcision rate was 26.44%. There were no significant differences in age, tumor subtypes, combined hashimoto′s thyroiditis, multiple lesions, FT3, FT4, TGAb and TPOAb between the metastatic group and the non-metastatic group ( P>0.05). The proportion of male patients in the metastatic group was higher than that in the non-metastatic group (32.81% vs 19.44%, χ2=4.38, P=0.036), the tumor diameter in the metastatic group was larger than that in the non-metastatic group [(0.63±0.23)cm vs (0.49±0.22)cm, χ2=3.99, P<0.001], and the preoperative TSH in the metastatic group was higher than that in the non-metastatic group[2.87(1.92, 4.95) vs 2.04(1.56, 2.84), Z=2.48, P=0.024], and differences between the two groups was statistically significant ( P<0.05). Multivariate logistic regression analysis showed that male, tumor diameter and preoperative TSH were independent risk factors for lymph node metastasis in central region ( P<0.05). Conclusions:The central lymph node metastasis rate of cN0 unilateral PTMC is high. Male, patients with large tumor diameter and high preoperative TSH should be alert to occult lymph node metastasis, and the protection of parathyroid glands should be strengthened during central lymph node dissection.