儿童及青少年甲状腺乳头状癌转移的临床特征分析

发布时间：2018-10-24 13:53

【摘要】：目的研究相关临床病例资料,探讨成人与儿童及青少年甲状腺乳头状癌在临床病理特征方面的差异。进一步分析儿童及青少年甲状腺乳头状癌转移特点及危险因素以指导临床治疗。方法回顾性研究2011年2月至2017年2月就诊于郑州大学第一附属医院甲状腺外科,首次行手术治疗并经术后常规病理确诊为甲状腺乳头状癌,发病年龄小于等于18岁的儿童及青少年患者的临床病例资料135份。同时收集首诊于我院,发病年龄大于18岁成人经手术治疗后常规病理结果为甲状腺乳头状癌病例资料120份。统计分析成人组与儿童及青少年组临床病理方面的差异。同时分析儿童及青少年组中患者的颈部淋巴结转移及肺转移临床特征及相关风险因素。结果135例儿童及青少年患者年龄从3岁至18岁,中位年龄为16岁。男性患者33例,女性患者102例。最大肿瘤直径7.5cm,最小直径0.3cm,肿瘤直径中位数1.7cm。肿瘤病灶单发96例,肿瘤病灶多发39例。肿瘤合并桥本31例,肿瘤未合并桥本104例。肿瘤侵犯被膜31例,肿瘤无被膜侵犯104例。颈部淋巴结转移97例,转移淋巴结中位数4个,无颈部淋巴结转移38例。肺转移17例,无肺转移118例。治疗后复发28例,治疗后无复发107例。120例成人患者年龄从23岁至74岁,中位年龄为45岁。男性患者26例,女性患者94例。最大肿瘤直径6cm,最小肿瘤直径0.1cm,肿瘤直径中位数0.9cm。肿瘤病灶单发85例,肿瘤病灶多发35例。肿瘤合并桥本13例,肿瘤未合并桥本107。肿瘤侵犯被膜16例,肿瘤无被膜侵犯104例。颈部淋巴结转移42例,转移淋巴结中位数0个,无颈部淋巴结转移78例。肺转移4例,无肺转移116例。治疗后复发8例,治疗后无复发112例。统计分析发现:1.成人甲状腺乳头状癌与儿童及青少年相比,在肿瘤直径(Z=-5.416)、淋巴结转移数(Z=-6.722)、肿瘤合并桥本(χ2=6.547)、被膜侵犯(χ2=3.918)、肺转移(χ2=7.207)、复发(χ2=10.379)有明显差异。2.经Spearman秩相关分析儿童及青少年甲状腺乳头状癌肿瘤直径大小与颈部淋巴结转移数相关,相关系数(r=0.221)。3.经logistic回归分析,肿瘤直径大小是儿童及青少年甲状腺乳头状癌颈部淋巴结转移的危险因素(OR=63.572),被膜侵犯、病灶数是儿童及青少年甲状腺乳头状癌肺转移的危险因素(OR值为6.598、10.933)。结论1.儿童及青少年甲状腺乳头状癌与成人相比,肿瘤直径较大,颈部淋巴结转移更严重,肿瘤合并桥本、被膜受侵犯、肺转移、复发几率较高。2.肿瘤直径大于1cm的儿童及青少年PTC发生颈部淋巴结转移的风险相对较高,且肿瘤直径越大,颈部淋巴结转移个数越多。3.对于被膜受侵犯、多病灶的儿童甲状腺乳头状癌患者,其发生肺转移的风险明显增加。
[Abstract]:Objective to investigate the clinicopathological characteristics of papillary thyroid carcinoma in adults, children and adolescents. To further analyze the characteristics and risk factors of papillary thyroid carcinoma metastasis in children and adolescents to guide the clinical treatment. Methods from February 2011 to February 2017, thyroid carcinoma was diagnosed as papillary thyroid carcinoma in the first affiliated Hospital of Zhengzhou University. 135 clinical data of children and adolescents aged less than 18 years. At the same time, 120 cases of papillary thyroid carcinoma were collected. The differences of clinicopathology between adults and children and adolescents were analyzed statistically. The clinical features and risk factors of cervical lymph node metastasis and lung metastasis in children and adolescents were analyzed. Results the age of 135 children and adolescents ranged from 3 to 18 years old, with a median age of 16 years. There were 33 males and 102 females. The maximum diameter of tumor was 7.5 cm, the minimum diameter was 0.3 cm, and the median diameter of tumor was 1.7 cm. There were 96 cases with single tumor focus and 39 cases with multiple tumor focus. There were 31 cases of tumor with Hashimoto and 104 cases of tumor without Hashimoto. There were 31 cases of tumor invasion of the capsule and 104 cases of tumor without invasion of the capsule. There were 97 cases of cervical lymph node metastasis, 4 cases of metastatic lymph node and 38 cases of no cervical lymph node metastasis. There were 17 cases of lung metastasis and 118 cases of no lung metastasis. The age of 120 adult patients ranged from 23 to 74 years old, with a median age of 45 years. There were 26 males and 94 females. The maximum tumor diameter was 6 cm, the smallest tumor diameter was 0.1 cm, and the median tumor diameter was 0.9 cm. There were 85 cases with single tumor focus and 35 cases with multiple tumor focus. There were 13 cases of tumor with Hashimoto and 107 cases of tumor without Hashimoto. There were 16 cases of tumor invading the capsule and 104 cases of tumor without invasion of the capsule. There were 42 cases of cervical lymph node metastasis, the median of metastatic lymph nodes was 0, and 78 cases without cervical lymph node metastasis. Pulmonary metastasis occurred in 4 cases and no lung metastasis in 116 cases. There were 8 cases of recurrence after treatment and 112 cases of no recurrence after treatment. Statistical analysis found that: 1. Compared with children and adolescents, there were significant differences in diameter of tumor (Z _ (-5.416), number of lymph node metastasis (Z ~ (-6.722), tumor with Hashimoto (蠂 ~ (2) 6.547), invasion of membrane (蠂 ~ (2) = 3.918), pulmonary metastasis (蠂 ~ (22n) 7.207) and recurrence (蠂 ~ (210.379) in adult thyroid papillary carcinoma. The diameter of papillary thyroid carcinoma in children and adolescents was correlated with the number of cervical lymph node metastasis by Spearman rank correlation analysis (r = 0.221). Logistic regression analysis showed that tumor diameter was a risk factor for cervical lymph node metastasis (OR=63.572) in children and adolescents, and the number of lesions was a risk factor for lung metastasis in children and adolescents (OR = 6.59810. 933). Conclusion 1. Compared with adults, papillary thyroid carcinoma in children and adolescents is larger in diameter, more serious in cervical lymph node metastasis, and more likely to recur with Hashimoto, membranous invasion, lung metastasis and recurrence. Children and adolescents with tumor diameter larger than 1cm had a higher risk of cervical lymph node metastasis, and the larger the tumor diameter, the greater the number of cervical lymph node metastasis. In children with papillary thyroid carcinoma with multiple lesions, the risk of lung metastasis was significantly increased.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1
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本文编号：2291595