甲状腺乳头状癌颈部淋巴结转移相关危险因素研究

发布时间：2018-04-11 04:30

  本文选题：甲状腺乳头状癌 + 甲状腺微小乳头状癌　； 参考：《广西医科大学》2017年硕士论文

【摘要】：目的:探讨甲状腺乳头状癌淋巴结转移相关危险因素。方法:收集于2002年07月至2016年06月在我科诊治的甲状腺乳头状癌患者202例,所有患者均行颈部淋巴结清扫术,其中行中央+侧颈区淋巴结清扫术93例,单纯行中央区淋巴结清扫术109例。纳入患者的性别、年龄、病灶单双侧、肿瘤直径、是否多发病灶、是否微小癌及术前血小板计数、合并慢性全身性疾病、吸烟史、饮酒史等因素,与颈部淋巴结转移情况。计数资料用频数表示,两组率的比较即单因素分析采用卡方检验,相应P值0.1的因素进行后续的多因素分析。多因素分析采用二分类Logistic回归分析。以P0.05(双侧)为差异有统计学意义。结果:202例患者中,共有颈部淋巴结转移96例。单因素分析显示:性别(X~2=4.589,P=0.032)、年龄(X~2=11.384,P=0.001)、单双侧病灶(X~2=9.700,P=0.002)、微小癌(X~2=8.020,P=0.005)、血小板计数(X~2=7.980,P=0.005)与甲状腺乳头状癌颈部淋巴结转移有关。多因素二分类Logistic回归分析显示:性别(P=0.045,OR=0.461,95%CI=0.216-0.984)、年龄(P=0.004,OR=0.357,95%CI=0.176-0.726)、单双侧病灶(P=0.001,OR=6.610,95%CI=2.280-19.169)、血小板计数(P=0.005,OR=3.282,95%CI=1.438-7.491)、微小癌(P=0.001,OR=0.215,95%CI=0.083-0.555)为甲状腺乳头状癌颈部淋巴结转移的独立影响因素。在研究中央区淋巴结转移的患者出现侧颈部淋巴结转移风险分析中,单因素分析显示:性别(X~2=5.800,P=0.016)、年龄(X~2=9.896,P=0.002)与甲状腺乳头状癌侧颈部淋巴结转移相关,多因素分析发现:性别(P=0.026,OR=0.199,95%CI=0.048-0.827)、年龄(P=0.002,OR=0.153,95%CI=0.046-0.516)为甲状腺乳头状癌侧颈部淋巴结转移的独立影响因素。40例微小乳头状癌患者分析中,我们发现单双侧病灶与其颈部淋巴结转移风险相关(X~2=7.343,P=0.007)。经对84例甲状腺癌cN0患者分析后发现术前血小板计数与其颈部淋巴结转移相关(X~2=5.411,P=0.020)。结论:男性、年龄≤45岁、双侧病灶、血小板计数300×109/L、肿瘤直径1cm是甲状腺乳头状癌颈部淋巴结转移的危险因素。对于中央区淋巴结转移的患者,男性、年龄≤45岁是其出现侧颈部淋巴结转移的独立危险因素。双侧病灶与甲状腺乳头状微小癌患者颈部淋巴结转移有关。术前血小板计数与cN0甲状腺乳头状癌患者颈部淋巴结转移有关。
[Abstract]:Objective: to investigate the risk factors associated with lymph node metastasis in papillary thyroid carcinoma.Methods: 202 patients with papillary thyroid carcinoma were collected from July 2002 to June 2016. All the patients underwent neck lymph node dissection, 93 of them underwent central neck dissection.109 cases underwent central lymph node dissection.Gender, age, unilateral and bilateral lesions, tumor diameter, multiple lesions, microcarcinoma and preoperative platelet count, chronic systemic disease, smoking history, drinking history, and cervical lymph node metastasis were taken into account.The counting data are expressed by frequency. The comparison between the two groups is that the single factor analysis is chi-square test, and the corresponding P value 0.1 is used to carry on the subsequent multivariate analysis.Two-classification Logistic regression analysis was used for multivariate analysis.There was significant difference in P 0.05 (bilateral).Results among 202 cases, 96 cases had cervical lymph node metastasis.In the analysis of the risk of lateral cervical lymph node metastasis in patients with lymph node metastasis in central region, univariate analysis showed that the sex of the patients with papillary thyroid carcinoma was 5.800%, the age was 9.896%, and the age was 9.896% (P 0.002), which was associated with the cervical lymph node metastasis of papillary thyroid carcinoma.The multivariate analysis showed that the sex of the papillary thyroid carcinoma was 0.048-0.827 and 0.15395CIQ 0.046-0.516). In the analysis of 40 patients with papillary thyroid carcinoma, we found that the single and bilateral lesions were associated with the risk of cervical lymph node metastasis. We found that the single and bilateral lesions were associated with the risk of cervical lymph node metastasis in patients with papillary thyroid carcinoma.After analysis of 84 cases of thyroid carcinoma with cN0, it was found that preoperative platelet count was associated with cervical lymph node metastasis.Conclusion: male, age 鈮，

本文编号：1734459