| Objective: To investigate the clinicopathological features of multifocal papillary thyroid carcinoma(MPTC)and analyze the risk factors associated with metastasis to the lymph nodes in the neck,in order to provide a reference for the surgical treatment of papillary thyroid carcinoma.Methods: A retrospective study of 1025 patients who underwent first-time thyroid surgery and were diagnosed with papillary thyroid carcinoma by postoperative paraffin pathology was conducted to investigate the clinicopathological features associated with multifocal PTC using SPSS software and univariate analysis.Multi-factor logistic regression analysis was applied to investigate the independent risk factors for the development of metastasis in the central region of the neck and lateral lymph nodes of the neck.Results:1.Single-factor analysis of clinicopathological characteristics of patients with multifocal PTC(1)Compared with patients with unifocal PTC,the rates of obesity,combined Hashimoto’s thyroiditis,maximum lesion diameter greater than 1 cm,total lesion diameter greater than 1 cm,central cervical region,lateral cervical lymph node metastasis and invasion of the outer thyroid gland peritoneum were higher in patients with multifocal PTC(P < 0.001);In terms of gender,age,preoperative TSH and TG levels,the differences were not statistically significant in the multifocal group compared with the single-focal group(P > 0.05).(2)As the number of lesions increased,the proportion of extra-thyroidal invasion,central cervical area and lateral lymph node metastasis increased linearly(P < 0.001,with a linear trend of increasing differences among n=1,n=2 and n≥3 groups);(3)Compared with the unilateral multifocal group,the proportion of patients with maximum diameter of lesions and total diameter of lesions >1 cm was higher in the bilateral group of lesions(P = 0.001;P < 0.001);the probability of metastasis in the central and lateral lymph nodes was higher in the bilateral multifocal group(P <0.001;P = 0.004).2.In PTC,two groups were divided according to the central zone lymph node metastasis or not,and the clinicopathological characteristics of the two were compared.(1)Compared with the negative group,the positive group with lymph node metastasis in the central region had a higher proportion of males,multiple foci,lesions with a maximum diameter >1 cm,and extraglandular invasion(P < 0.001);the positive group had a higher incidence of age <55 years,preoperative TG level >55 ng/ml,and combined HT(P <0.05);There was no difference statistically between the the two groups with regard to preoperative TSH levels and whether obesity was present.(P > 0.05);(2)Multi-factor binary logistic results showed that men(OR: 1.836,95% CI: 1.341-2.514,P < 0.001),age< 55 years(OR: 1.656,95% CI: 1.166-2.353,P < 0.01),preoperative TG > 55ng/ml(OR:1.695,95% CI: 1.129-2.545,P < 0.05),multifocal(OR: 1.508,95% CI: 1.121-2.028,P <0.01),lesions >1 cm in maximum diameter(OR: 3.648,95% CI: 2.675-4.974,P < 0.001),extra-thyroidal gland invasion(OR: 2.637,95% CI: 1.826-3.808,P < 0.001)were independent risk factors for the development of lymph node metastasis in the central neck region.3.The lateral cervical lymph nodes were divided into two groups according to whether they metastasized or not,positive metastasis group and negative non-metastasis group,and the clinicopathological characteristics of the two groups were compared.(1)In terms of obesity,preoperative TG > 55 ng/ml,multifocal,lesion maximum diameter > 1 cm,a positive lymph node in the Central area,as well as extra-glandular invasion,was more likely to occur in the group with positive lateral cervical lymph node metastasis(p<0.001);a higher percentage of patients in the group with positive lateral cervical lymph node metastasis were male and <55 years old(P < 0.01;P = 0.039);the two groups had no statistical differences in TSH,combined HT were not statistically different compared with each other(P > 0.05);(2)multifactorial logistic results showed that obesity(OR: 1.747,95% CI: 1.086-2.809,P < 0.05),preoperative TG > 55ng/ml(OR: 2.632,95% CI: 1.556-4.450,P < 0.001)(OR: 2.462,95% CI: 1.558-3.891,P < 0.001),multiple foci(OR: 2.462,95% CI: 1.558-3.891,P < 0.001),lesions >1 cm in maximum diameter(OR: 1.982,95%CI: 1.238-3.174,P < 0.01),lymph node metastasis in the central region(OR: 5.157,95%CI: 2.987-8.902,P < 0.001)and extraglandular invasion(OR: 2.355,95% CI: 1.451-3.824,P < 0.01)were risk-independent facts for the occurrence of lateral lymph node metastasis in the cervix.To further investigate the effect of the number of lymph node metastases in the central area on the lateral lymph node metastases,ROC curves for the specific number of lymph node metastases in the central area were drawn,with a total area under the curve of 0.834 and a maximum value of 0.6 for the Yordon index,whose corresponding sensitivity,specificity and cut-off values were 69.6%,90.4% and 3.5,respectively.Conclusion: 1、The proportion of lymph node metastasis in the neck and extraglandular invasion in the thyroid gland were higher in MPTC patients than in unifocal PTC,and the proportion of lymph node metastasis and extraglandular invasion in the neck increased step by step with the increase of the number of lesions.2、The proportion of lymph node metastasis and extraglandular invasion in bilateral multifocal PTC was higher than that in unilateral multifocal PTC.3、Male,age less than 55 years,tumor size greater than 1.0 cm,multifocality,ETE and TG more than 55ng/ml are independent risk factors for CLNM.4、Obesity,tumor size greater than 1.0 cm,multifocality,ETE,CLNM and TG over 55ng/ml were factors leading to increased risk of LLNM,and the number of CLNM had better predictive value for LLNM when the cut-off value of CLNM was 3.5 pieces. |
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