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Received:May 31, 2023 Published Online:November 20, 2023
Received:May 31, 2023 Published Online:November 20, 2023
中文摘要: 目的 对多灶性甲状腺乳头状癌(MPTC)的临床和病理学特点进行分析,并探讨其治疗策略。方法 收集2016年7月至2019年10月在江苏省中医院首次行甲状腺手术并经术后病理证实为甲状腺乳头状癌(PTC)的患者共601例的临床资料,回顾性比较MPTC与单灶性PTC(SPTC)的临床和病理学特点,对MPTC的发病风险进行logistic回归分析;并分析MPTC患者中央区淋巴结转移的危险因素。结果 601例患者中,MPTC共202例,占33.6%,其中甲状腺双侧癌150例,占MPTC 的74.3%。MPTC患者中,中央区淋巴结转移率和侧颈区淋巴结转移率分别为60.9%(123/202)和13.4%(27/202)。MPTC组患者在身体质量指数(BMI)≥25 kg/m2、合并桥本甲状腺炎(HT)、肿瘤最大径≥1 cm、甲状腺包膜受侵、中央区和侧颈区淋巴结转移等方面的比例均高于SPTC组(P<0.05)。MPTC中央区淋巴结转移患者男性、年龄<55岁、肿瘤最大径≥1 cm、全部肿瘤最大径之和≥1 cm及甲状腺包膜受侵的比例高于无转移患者(P<0.05);中央区淋巴结转移组合并结节性甲状腺肿的比例低于未转移组(44.7% vs 62.0%, χ2=5.770,P<0.05)。结论 MPTC患者双侧癌比例高;BMI≥25 kg/m2、合并HT及甲状腺包膜受侵的PTC患者存在MPTC可能性大,建议行甲状腺全切除术。男性、年龄<55岁、甲状腺包膜侵犯的MPTC患者中央区淋巴结转移发生率更高,建议行双侧中央区淋巴结清扫术。
Abstract:ObjectiveTo analyze the clinicopathological features of multifocal papillary thyroid carcinoma (MPTC) and to explore its treatment strategy. Methods The clinical data of 601 patients with thyroid papillary carcinoma(PTC) who underwent the first thyroid surgery in Jiangsu Province Hospital of Chinese Medicine from July 2016 to October 2019 were analyzed retrospectively. The clinicopathological characteristics of MPTC and solitary papillary thyroid carcinoma (SPTC) were compared, and the risk factors for MPTC and central lymph node metastasis(CLNM) were analyzed. Results Among the 601 cases, there were 202 cases of MPTC, accounting for 33.6%, including 150 cases of bilateral thyroid cancer, accounting for 74.3% of MPTC. Among MPTC patients, the central and lateral neck lymph node metastasis rates were 60.9% (123/202) and 13.4% (27/202), respectively. The proportion of MPTC patients with body mass index (BMI)≥25 kg/m2, combined with Hashimotos thyroiditis (HT), tumor maximum diameter≥1 cm, thyroid capsule invasion, lymph node metastasis in central and lateral neck areas were higher than those in SPTC group (P<0.05). The proportion of male, age<55 years old, tumor maximum diameter≥1 cm, sum of tumor maximum diameter≥1 cm and thyroid capsule invasion of patients with CLNM in MPTC patients were higher than those of patients without CLNM (P<0.05). The proportion of patients with nodular goiter in CLNM patients was lower than that in patients without CLNM (44.7% vs 62.0%, χ2=5.770,P<0.05). Conclusion The rate of bilateral cancer is high in MPTC patients. PTC patients with BMI≥25 kg/m2, combined with HT and thyroid capsule invasion are more likely to have MPTC, and total thyroidectomy is recommended. The incidence of CLNM is higher in MPTC patients with male, age<55 years old and thyroid capsule invasion, and bilateral central lymph node dissection is recommended.
keywords: Thyroid cancer Papillary thyroid carcinoma, multifocal Central lymph node metastasis Nodular goiter Hashimotos thyroiditis Capsule invasion
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基金项目:江苏省中医院科主任提升计划(Y2021ZR03)
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