| Objective:To study the traditional Chinese medicine syndromes of stage cN0 papillary thyroid carcinoma,analyze the risk factors of central lymph node metastasis,and explore the correlation between the type and risk factors,as well as the type and central lymph node metastasis,so as to provide clinical basis for the reasonable selection of integrated Chinese and Western medicine treatment and surgical methods for stage cN0 papillary thyroid carcinoma.Methods:A total of 95 patients with stage cN0 papillary thyroid carcinoma who received surgical treatment in the Department of Breast and Thyroid Surgery,Affiliated Hospital of Shandong University of Chinese Medicine from October2020 to October 2021 and met the inclusion criteria were collected.Fill in《the cN0 Thyroid papillary carcinoma Questionnaire》,collect patients’ basic data,traditional Chinese medicine observation,hearing,inquiry and incision information for syndrome differentiation and type classification.The number of central lymph node metastasis and the possible risk factors of central lymph node metastasis were analyzed.In this study,SPSS 26.0 and r4.2.2 software were used for data analysis,and the counting data were statistically described by the number of cases(n)and percentage(%).Chi-square test or Fisher exact probability method were used to analyze the influencing factors of central lymph node metastasis in patients with cN0 thyroid papillary carcinoma.The variables with statistical significance in univariate analysis(P<0.05)were included in the multiple logistic regression analysis to further determine the independent influencing factors of lymph node metastasis.Fisher’s exact probability method was used to analyze the relevant factors of different syndrome types.In order to further clarify the relevant influencing factors of hepatoptosis and spittoon type,the variables with statistical significance in univariate analysis(P<0.05)were included in the multiple logistic regression analysis,with hepatoptosis or spittoon type as the dependent variable.P < 0.05 was considered statistically significant.Results:1.The central lymph node metastasis rate of stage cN0 thyroid papillary carcinoma was 62.1%(59/95),and the incidence rate of male was lower than that of female(1:2.39).Univariate analysis showed that: male,age between30 and 39 years old,multiple tumors,tumor invasion of capsule,tumor located in the lower pole of thyroid,tumor diameter ≥2cm,preoperative color doppler ultrasonography indicated calcification,the proportion of these factors in the positive group was significantly higher than that in the negative group,indicating that they were correlated with central lymph node metastasis(P< 0.05).Hashimoto’s thyroiditis Thyroiditis and nodular goiter had no correlation with central lymph node metastasis(P > 0.05).Multivariate analysis showed that male and tumor diameter ≥2cm were independent risk factors for central lymph node metastasis(P < 0.05)(OR > 1),and age between40 and 59 was negatively correlated with central lymph node metastasis(P <0.05)(OR < 1).2.TCM syndrome differentiation of thyroid papillary carcinoma in cN0 stage included 42 cases of Qi stagnation and blood stasis,32 cases of liver stagnation and phlegm,36.4%,and 14 cases of Qi and Yin deficiency,15.9%.Central lymph node metastasis of Qi stagnation and blood stasis type(25/40),metastasis rate of 62.5%;liver stagnation and phlegm type(29/45),metastasis rate of 64.4%;Qi and blood deficiency type(5/10),metastasis rate of 50%.There were 40 cases of qi stagnation and blood stasis type,25 cases of central lymph node metastasis were confirmed by pathology after surgery,16 cases of1-5 metastasis,9 cases of > 5 metastasis.There were 45 cases with liver depression and phlegm type,and 29 cases with central lymph node metastasis were confirmed by pathology after operation,of which 15 cases had 1-5metastasis,and 14 cases had > 5 metastasis.There were 10 cases with both Qi and Yin deficiency,and 5 cases with central lymph node metastasis were confirmed by pathology after surgery,among which 3 cases had 1-5 metastasis and 2 cases had > 5 metastasis.After analysis,there was no correlation between the three syndrome types and central lymph node metastasis(P > 0.05).3.Among the three TCM syndrome types of thyroid papillary carcinoma in cN0 stage,univariate analysis showed that liver depression and spittoon were more likely to have multiple tumor foci,tumors were more likely to invade the capsule,and preoperative color ultrasound indicated a higher probability of calcification(p < 0.05).Multivariate logistic regression analysis showed that multiple tumor foci and tumor invasion of capsule were independent risk factors for cN0 stage thyroid papillary carcinoma liver depression spittoon type(P < 0.05)(OR > 1).Conclusion:1.In the patients with stage cN0 papillary thyroid carcinoma,male patients aged 30-39 years old,multi-focal patients with tumor invasion of capsule,tumors located at the lower pole of thyroid,tumor diameter ≥2cm,and patients with preoperative color ultrasound indicating calcification were more likely to have central lymph node metastasis;Male and tumor diameter≥2cm were independent risk factors for central lymph node metastasis in cN0 stage thyroid papillary carcinoma,and age between 40 and 59 years was negatively correlated with central lymph node metastasis.2.There was no correlation between Qi stagnation and blood stasis,liver depression spittoon coagulation,Qi and Yin deficiency and lymph node metastasis and the number of lymph node metastasis in stage cN0 thyroid papillary carcinoma patients.3.Patients with stage cN0 thyroid papillary carcinoma with liver depression and spittoon are more likely to have multiple tumor foci,and the tumor is more likely to invade the capsular membrane.Preoperative color Doppler ultrasound indicates a higher probability of calcification,while patients with liver depression and spittoon with multiple tumor foci or invasion of the dorsal membrane are more likely to have central lymph node metastasis. |
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