1988例甲状腺微小乳头状癌（PTMC）临床病理特征及颈部中央区淋巴结危险因素分析

发布时间：2018-03-10 11:43

本文选题：甲状腺微小乳头状癌　切入点：中央区淋巴结转移　出处：《新疆医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探讨甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)临床病理特征及中央区淋巴结转移(the central lymph node metastasis,CLNM)风险因素;尤其探讨不同确诊年龄截点与CLNM相关性,阐述年龄意义;对比肿瘤最大经(the primary tumor diameter,PTD)、癌灶总直径(the total tumor diameter,TTD)与CLNM危险因素研究结果,阐述TTD衡量多灶PTMC大小合理性。方法:回顾性分析新疆医科大学附属肿瘤医院2010年1月至2016年3月初治的PTMC患者临床病理特征,通过X2检验、ROC曲线及多因素统计分析,探讨CLNM风险因素。结果:CLNM率为34.9%。多因素分析显示,男性、确诊年龄45岁、肿瘤数目≥3个、肿瘤直径5mm、伴微小或伴微小+粗大钙化、包膜浸润、不伴甲炎、不伴结节性甲状腺肿是影响CLNM独立危险因素(均P0.05);而肿瘤位置、包膜外侵犯、伴粗大钙化与CLNM差异无统计学意义。除70岁截点外,25~70岁年龄区间中每5岁为截点及30~60岁年龄区间中每岁为截点均有统计学差异,即上述确诊年龄截点均可提示确诊年龄是CLNM独立危险因素。与PTD相比,将TTD作为多灶PTMC大小,更能表明肿瘤直径与CLNM相关性及变化趋势。肿瘤位置是单灶CLNM独立危险因素,当其位于下极,CLNM率最高;而多灶肿瘤位置与CLNM无关(P=0.211)。结论:当PTMC存在以下情况,如:男性、数目≥3个、肿瘤直径5mm、伴有微小或伴有微小+粗大钙化、包膜浸润、不伴有结节性甲状腺肿、不伴有甲炎、单灶位于下极,应警惕CLNM可能。其次,年龄仅代表变化趋势,无确定截点;将年龄看成连续型变量,在相关研究结果阐述中更加合理。与PTD相比,TTD是多灶PTMC真正大小。
[Abstract]:Objective: to investigate the clinicopathological features of papillary thyroid microcarcinoma of thyroid micropapillary carcinoma and the risk factors of central lymph node metastasis of the central lymph nodes, especially to explore the correlation between different diagnostic age points and CLNM, and to elucidate the significance of age. Compared with the study of the primary tumor diameterus, the total diameter of the tumor focus and the total tumor diameterus, the results of the study on the risk factors of CLNM were compared. Methods: the clinicopathological characteristics of PTMC patients treated from January 2010 to early March 2016 in affiliated Cancer Hospital of Xinjiang Medical University were analyzed retrospectively. The multivariate analysis showed that the age of diagnosis was 45 years old, the number of tumors was more than 3, the diameter of the tumor was 5 mm, the diameter of the tumor was 5 mm, with small or small calcification, capsule infiltration, no thyroiditis. No nodular goiter was an independent risk factor for CLNM (all P 0.05), and tumor location, extracapsular invasion. There was no significant difference between coarse calcification and CLNM. There were significant differences in the cut-off points of 2570 years old and 30 ~ 60 years old except for 25 ~ 70 years old and 30 ~ 60 years old. Compared with PTD, using TTD as the size of multi-focus PTMC can better indicate the correlation between tumor diameter and CLNM, and the location of tumor is an independent risk factor for single focus CLNM, which indicates that the age of diagnosis is an independent risk factor for CLNM. When the tumor was located at the lower pole, the rate of CLNM was the highest, and the location of multi-focus tumor was not related to CLNM. Conclusion: when PTMC exists, for example, male, the number is more than 3, the diameter of tumor is 5 mm, with small or small coarse calcification and capsule infiltration. There is no nodular goiter, no thyroiditis, single focus is at the lower pole, we should be aware of the possibility of CLNM. Secondly, age only represents the trend of change, there is no definite cut-off point; the age is regarded as a continuous variable. Compared with PTD, TTD is the real size of multifocal PTMC.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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