体重指数与甲状腺乳头状癌临床病理特征的关系：回顾性研究

发布时间：2018-04-18 00:27

本文选题：BMI + 肥胖　；参考：《济南大学》2017年硕士论文

【摘要】：目的甲状腺乳头状癌(Papillary Thyroid Carcinoma,PTC)发病率近年来持续攀升,肥胖已被认为是甲状腺乳头状癌发病的独立危险因素。然而,体重增加是否促进PTC恶性生物学行为,影响PTC预后尚不明确。本研究目的为明确体重指数(Body Mass Index,BMI)与甲状腺乳头状癌的临床病理特征的关系。方法796例甲状腺乳头状癌患者入组回顾性分析。Logistic回归模型用于评价BMI增加与各临床病理特征相关性的OR值。进一步利用Logistic回归模型进行组间对比,分析超重组(overweight)、肥胖组(obese)患者临床病例特征差异,分析过程中正常体重组(normal weight)作为对照组。采用非参数检验分别比较超重组、肥胖组与正常体重组中央区及侧颈部淋巴结转移数差异。结果本研究入组796例患者,男性:女性患者比例约1:3,入组人群平均年龄为(46.2±11.5)岁,平均体重指数为(25±3.40)kg/m2。Logistic回归分析显示:体重指数增加与甲状腺乳头状癌肿瘤大小(OR=1.267,P=0.027)、侵犯包膜(OR=2.201,P0.001)、多发灶(OR=1.31,P=0.01)、肿瘤分期较晚(OR=1.479,P=0.004)存在明确相关性。利用Logistic回归模型组间对比分析显示超重组、肥胖组相对于正常体重组肿瘤大小1cm的OR值分别为1.53(CI:1.14-2.06,P=0.005)、1.96(CI:1.15-3.34,P=0.014),发生侵犯包膜的OR值分别为2.42(CI:1.78-3.3,P0.001)、4.23(CI:2.4-7.3,P0.001);超重组较正常体重组临床分期较晚的OR值为1.83(CI:1.33-2.52,P0.001);肥胖组较正常体重组发生侧颈部(II-V区)±中央区淋巴结(VI区)淋巴结转移的OR值为1.92(CI:1.12-3.27,P=0.017)。非参数检验进一步分析BMI与颈部淋巴结转移的相关性,分析结果显示超重组转移至中央区和侧颈部淋巴结数目较正常体重组增加且差异有统计学意义(P=0.014、P=0.05);肥胖组转移至中央区和侧颈部淋巴结数目较正常体重组增加且差异有统计学意义(P=0.013、P=0.017)。结论高BMI与甲状腺乳头状癌肿瘤大小、侵犯包膜、颈部淋巴结转移等侵袭性临床病理特征存在相关性。高体重指数患者初次就诊时肿瘤TNM分期普遍较晚。这项研究表明超重与肥胖人群应采取更为积极的PTC治疗方案,但这需要进一步研究证明。
[Abstract]:Objective the incidence of papillary Thyroid carcinomas has been increasing in recent years. Obesity has been regarded as an independent risk factor for papillary thyroid carcinoma.However, it is not clear whether weight gain promotes PTC malignant biological behavior and affects the prognosis of PTC.Objective to study the relationship between body Mass index (BMI) and clinicopathological features of papillary thyroid carcinoma.Methods 796 patients with papillary thyroid carcinoma were analyzed retrospectively. Logistic regression model was used to evaluate the OR value of the correlation between the increase of BMI and the clinicopathological characteristics.Further more, Logistic regression model was used to compare the clinical characteristics of patients with hyperrecombination overweight and obesity, and normal weight group was used as control group in the course of analysis.Nonparametric tests were used to compare the number of lymph node metastases in the central region and lateral neck between the obese group and the normal weight group.Results there were 796 patients in this study. The proportion of male to female patients was about 1: 3. The average age of the group was 46.2 卤11.5 years old.The average body mass index (BMI) was 25 卤3.40)kg/m2.Logistic regression analysis. The results showed that there was a clear correlation between the increase of BMI and the size of thyroid papillary carcinoma tumor (1.267 P0.027), the invasion of the capsule (2.201) (P0.001), the multiple foci (OR1.31) and the late stage of the tumor (1.479P0.004).The results of Logistic regression model showed superrecombination.The OR values of tumor size 1cm in obese group were 1.53 CI: 1.14-2.06P0. 005, CI: 1.15-3.34%, OR value of invading capsule were 2.42 CI: 1.78-3.3 P0.0014.23 CIV2.4-7.3P0.001; OR value of clinical stage of overweight group was 1.83 CI: 1.33-2.52P 0.001respectively; the OR value of overweight group was 1.83CI: 1.33-2.52P 0.001respectively, and that of obese group was 1.42CIw 1.78-3.3n (P 0.001) respectively; the OR value of overweight group was 1.83CI: 1.33-2.52P 0.001respectively; the OR value of obese group was 1.83% CI: 1.33-2.52U P0.001P 0.001r = 1.83CI: 1.33-2.52P 0.001respectively.The OR of lymph node metastasis was 1.92% CI: 1.12-3.27% (P < 0.017).Non-parametric test was used to analyze the correlation between BMI and cervical lymph node metastasis.The results showed that the number of lymph nodes transferred to the central area and lateral cervical lymph nodes in the obesity group was significantly higher than that in the normal body weight group, and the number of lymph nodes in the obesity group was higher and worse than that in the normal body weight group.The difference was statistically significant (P = 0.013, P = 0.017).Conclusion High BMI is associated with invasive clinicopathological features of papillary thyroid carcinoma, such as tumor size, invasion of capsule and cervical lymph node metastasis.Tumor TNM staging was generally late in patients with high body mass index (BMI) at first visit.The study suggests that overweight and obese people should take more aggressive PTC treatments, but this needs further research to prove.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1

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