合并慢性淋巴细胞性甲状腺炎的甲状腺乳头状癌的临床病理特点及淋巴结转移的风险分析

发布时间：2018-11-24 09:58

【摘要】：目的:探讨合并慢性淋巴细胞性甲状腺炎(Chronic Lymphocytic Thyroiditis,CLT)的甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理特点,特别是淋巴结转移风险的情况。方法:连续收集2013年10月至2015年10月期间在北京协和医院行手术治疗、经病理确诊的4265例PTC患者的临床病理资料,分析其临床病理特点,通过单因素分析明确合并CLT的PTC患者独特的临床病理特点;通过单因素、多因素统计分析确定包括CLT在内的各临床病理指标是否是淋巴结转移、大量淋巴结转移的独立危险因素。结果:4265例PTC患者中,甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)3059例(71.7%),伴CLT者1010例(23.7%)。合并CLT的PTC患者中,女性909例(90%)、中位年龄43岁、中位肿瘤长径0.8cm、多发灶624例(61.8%),侵犯被膜422例(41.8%),淋巴结转移429例(42.5%),大量淋巴结转移133例(13.2%)。与未合并CLT的PTC患者相比,合并CLT的PTC患者,女性比例多(90.0%vs 70.2%,P0.001);中位年龄低(43岁vs 44岁,P=0.001);淋巴结转移率低(42.5%vs 50.9%,P0.001);肿瘤长径、多发灶比例、侵犯被膜率、大量淋巴结转移率并无显明差异(0.8cm vs 0.7cm,61.8%vs 62.9%,41.8%vs 42.1%,13.2%vs14.5%,均P0.05)。淋巴结转移多因素分析显示:CLT是PTC淋巴结转移的独立保护因素(OR=0.713,95%CI=0.609-0.835,P0.001),但不是大量淋巴结转移的独立保护因素(OR=0.944,95%CI=0.750-1.188,P=0.621)。发生淋巴结转移的PTC患者中,合并CLT者的淋巴结转移数量与未合并者无差异(3个vs 3个,P=0.300)。结论:在合并CLT的PTC中,女性更多、更年轻、淋巴结转移率更低;CLT是PTC淋巴结转移的独立保护因素;但是发生转移的患者其淋巴结转移数量并未减少。
[Abstract]:Objective: to investigate the clinicopathological features of papillary thyroid carcinoma (papillary thyroid carcinoma,PTC) with chronic lymphocytic thyroiditis (Chronic Lymphocytic Thyroiditis,CLT), especially the risk of lymph node metastasis. Methods: the clinicopathological data of 4265 patients with PTC confirmed by pathology from October 2013 to October 2015 were collected and their clinicopathological characteristics were analyzed. The unique clinicopathological features of PTC patients with CLT were confirmed by univariate analysis. Univariate and multivariate statistical analysis was used to determine whether the clinicopathologic parameters, including CLT, were independent risk factors for lymph node metastasis and a large number of lymph node metastases. Results: of the 4265 patients with PTC, 3059 (71.7%) had (papillary thyroid microcarcinoma,PTMC and 1010 (23.7%) had CLT. Among the PTC patients with CLT, 909 cases (90%) were female. The median age was 43 years old. The median diameter of tumor was 0.8 cm, 624 cases (61.8%) had multiple foci, 422 cases (41.8%) had invasion of capsule, 429 cases (42.5%) had lymph node metastasis. There were 133 cases (13.2%) with massive lymph node metastasis. Compared with PTC patients without CLT, the proportion of PTC patients with CLT was higher (90.0%vs 70.2%, P0.001), the median age was lower (43 years, vs 44 years, P < 0.001). The lymph node metastasis rate was low (42.5%vs 50.9% P0.001); There was no significant difference in the length of tumor, the proportion of multiple foci, the rate of invasion of capsule, the rate of mass lymph node metastasis (0.8cm vs 0.7 cm ~ (-1) 61.8 vs 62.9). Multivariate analysis of lymph node metastasis showed that CLT was an independent protective factor (OR=0.713,95%CI=0.609-0.835,P0.001) for lymph node metastasis of PTC, but not an independent protective factor for a large number of lymph node metastases (OR=0.944,95%CI=0.750-1.188,). P0. 621). In PTC patients with lymph node metastasis, there was no difference in the number of lymph node metastasis between the patients with CLT and those without (3 vs, 0.300). Conclusion: in PTC with CLT, women are more, younger, and the rate of lymph node metastasis is lower, CLT is an independent protective factor of PTC lymph node metastasis, but the number of lymph node metastasis in patients with PTC metastasis has not decreased.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1;R581.4

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