甲状腺乳头状癌Delphian淋巴结转移的影响因素及临床意义研究

发布时间：2019-03-03 11:42

【摘要】：目的：本文目的是探究影响Delphian淋巴结的转移情况的临床因素以及其预测意义，并且探究Delphian淋巴结转移规律对甲状腺乳头状癌临床诊疗的指导作用。 方法：回顾性分析2013年9月到2015年1月就诊于吉林大学第一医院行手术治疗的探查到Delphian淋巴结并送检的182例术后石蜡病理确诊为甲状腺乳头状癌的病例，单因素分析研究相关临床因素（包括性别、年龄、肿瘤最大径，是否多灶，肿瘤是否侵犯甲状腺被膜、是否合并桥本甲状腺炎或结节性甲状腺肿或甲状腺腺瘤以及中央区气管旁淋巴结和侧颈淋巴结是否阳性）与Delphian淋巴结转移情况的相关关系，并对有统计学意义（P＜0.05）的临床因素进行logistic回归分析，进一步验证各临床因素的影响。对Delphian淋巴结的阳性个数与中央区气管旁淋巴结及侧颈淋巴结转移率做相关性分析，并研究Delphian淋巴结转移与肿瘤同侧及对侧Ⅵ区淋巴结转移情况的相关性。 结果：本研究中Delphian淋巴结转移与年龄（P=0.005）、肿瘤最大直径（P＜0.001）、是否侵及被膜（P=0.003）以及是否合并桥本甲状腺炎（P=0.015）的差异有统计学意义（P＜0.05）；与其他临床特征差异没有统计学意义；多因素logistic回归分析示肿瘤最大直径大于1cm，侵及甲状腺被膜的P值分别为＜0.001、0.038，OR值分别为4.895、2.563，95%的可信区间分别为2.401~9.981、1.055~6.226；中央区气管旁淋巴结转移率与Delphian淋巴结转移的个数的Kendall相关系数与Spearman相关系数均为1.000，P＜0.01，，侧颈淋巴结转移率与Delphian淋巴结转移个数Kendall相关系数为0.714，Spearman相关系数为0.739，P＜0.01；Delphian淋巴结阳性时患侧与对侧Ⅵ区的淋巴结转移率均较高（P＜0.05）。 结论：Delphian淋巴结的转移与患者年龄、肿瘤直径、是否侵犯被膜及被膜外组织以及是否合并桥本甲状腺炎等因素有关，肿瘤直径大于1cm、侵犯甲状腺被膜是Delphian淋巴结转移的危险因素；Delphian淋巴结阳性时中央区气管旁淋巴结和侧颈淋巴结转移率分别是Delphian阴性的3倍和1.5倍，并且转移率均与Delphian淋巴结的阳性个数呈正相关；Delphian淋巴结阳性癌灶同侧及对侧Ⅵ区的转移率均较高。
[Abstract]:Aim: the purpose of this study is to explore the clinical factors affecting the metastasis of Delphian lymph nodes and its predictive significance, and to explore the role of Delphian lymph node metastasis in the clinical diagnosis and treatment of papillary thyroid carcinoma. Methods: from September 2013 to January 2015, a total of 182 cases of thyroid papillary carcinoma diagnosed as thyroid papillary carcinoma by paraffin-embedded pathology were analyzed retrospectively. The Delphian lymph nodes were detected and examined in the first Hospital of Jilin University from September 2013 to January 2015. Univariate analysis was used to investigate related clinical factors (including sex, age, maximum diameter of tumor, multiple foci, and invasion of thyroid capsule). Whether Hashimoto's thyroiditis or nodular goiter or thyroid adenoma and paratracheal and lateral cervical lymph nodes in the central region were positive) were associated with Delphian lymph node metastasis. The clinical factors with statistical significance were analyzed by logistic regression analysis, and the influence of each clinical factor was further verified. The correlation between the number of positive Delphian lymph nodes and the rate of paratracheal and lateral cervical lymph node metastasis in the central region was analyzed, and the correlation between the Delphian lymph node metastasis and the lymph node metastasis in the ipsilateral and contralateral regions of the tumor was also studied. Results: in this study, Delphian lymph node metastasis and age (P < 0. 005), maximum tumor diameter (P < 0.001), and lymph node metastasis (P < 0. 005). There were significant differences in invasion of membrane (P < 0.05) and Hashimoto's thyroiditis (P < 0.05). There was no significant difference between them and other clinical features. Multivariate logistic regression analysis showed that the maximum diameter of the tumor was more than 1cm, the P value of invading thyroid capsule was < 0.001,0.038, OR value was 4.895, 2.563, and 95% confidence interval was 2.401 ~ 9.981,1.055 ~ 6.226, respectively (P < 0.001, P = 0.038, OR = 4.895,2.563,95% CI = 2.401 ~ 9.981, 1.055 ~ 6.226, respectively). The correlation coefficient between the paratracheal lymph node metastasis rate and the number of Delphian lymph node metastasis in the central region was 1.000 (P < 0.01), and the Kendall correlation coefficient between the lateral neck lymph node metastasis rate and the number of Delphian lymph node metastasis was 0.714, the correlation coefficient was 1.000 (P < 0.01). The correlation coefficient of Spearman was 0.739, P < 0.01; The lymph node metastasis rate in both the affected side and the contralateral part 鈪

本文编号：2433666