Analysis of risk factors for lymph node meta-stasis in papillary thyroid microcarcinoma / 国际外科学杂志

ABSTRACT

Objective To investigate the clinical and pathological characteristics of cervical lymph node metastasis in papillary thyroid microcarcinoma (PTMC),and provide a basis for the individualized surgical procedure.Methods Retrospectively analyzed the clinical data of 940 PTMC patients admitted to the Department of Thyroid Surgery,the First Affiliated Hospital of Zhengzhou University,from January 2016 to June 2018,including 206 males and 734 females,with a gender ratio of 1.0∶ 3.6.Age ranged from 18 to 78,with an average of (45.5± 10.6) years.The correlation between gender,age,cancer size,muhifocality,BRAFV600E gene mutation,complicated with hashimoto's thyroiditis,extrathyroidal extension and lymph node metastasis were analyzed.SPSS 21.0 software was used for statistical analysis.Chi-square test or rank sum test was adopted for comparison between groups,and logistic regression analysis was adopted for multivariate analysis.Results There were 397 (42.2％) patients with central lymph node metastasis (CLNM) and 104 (11.1％) patients with lateral lymph node metastasis (LLNM).Univariate analysis showed that male,age ＜ 55 years old (x2 =24.485,P ＜ 0.001),bilateral cancer foci (x2 =8.100,P =0.004),larger length-diameter (Z =-0.016,P ＜0.001),and BRAFV600E gene mutation (x2 =4.918,P =0.027) had a higher CLNM positive proportion,and LLNM positive proportion was higher in male (x2 =6.584,P =0.010),bilateral cancer foci (x2 =26.669,P ＜0.001),larger length-diameter (Z=-4.991,P ＜0.001),extra-glandular invasion (x2 =16.862,P ＜0.001).Multivariate logistic regression analysis showed that gender (OR =2.091,P ＜0.001),age (OR =1.551,P =0.010),cancer lesion length (OR =5.285,P ＜ 0.001) and BRAFV600E gene mutation (OR =1.648,P =0.038) were independent risk factors for CLNM in PTMC patients.Gender (OR =1.657,P =0.032),bilateral lesion (OR =2.610,P ＜ 0.001),tumor length diameter (OR =7.420,P ＜ 0.001) and extrathyroidal extension (OR =2.611,P =0.005) were independent risk factors for LLNM.The optimal critical values of tumor lesion length-diameter for risk assessment in CLNM and LLNM were 0.6 cm and 0.8 cm,respectively.Conclusions For PTMC patients with negative cervical lymph node had risk factors for lymph node metastasis,preventive dissection of central lymph nodes was recommended,and preventive dissection of lateral lymph nodes should also be comprehensively considered,by evaluating the extrathyroidal extension.