Analysis Of The Clinical Features And Risk Factors Of Central Lymph Node Metastasis In Familial Non-Medullary Thyroid Carcinoma

Objective: In order to investigate the reasonable clinical treatment method,we make a retrospective analysis of the clinical pathologic features and the risk factors of central lymph node metastasis in familial non-medullary thtroid carcinoma(FNMTC).Methods: We make a retrospective analysis of the clinical data of 1760 patients,who were diagnosed as thyroid carcinoma and accepted the operation surgery by the same surgeon of Department of Thyroid Surgery in the First Hospital of Jilin University.And their diagnosis were confirmed as papillary thyroid carcinoma after the postoperative paraffin pathological diagnosis.Among them,144 patients were with familial thyroid carcinoma and 1616 with sporadic.A comparative study was made between the 144 cases and the 1616 sporadic ones to search the difference of clinical features between them.By the time,we compare the clinical characteristics between the familial non-medullary thyroid microcarcinoma and the sporadic thyroid carcinoma.According to the relationship of the patients from familial ones,we divide them into parent-offspring group and the sibling group.Comparative studies were made between the groups and the sporadic patients.Also,we analyze the clinical features between the first generation patients and the second ones of the parent-offspring group. Through the single factor analysis to find out the significant risk factors of central lymph node metastasis in familial non-medullary thtroid carcinoma,we make a multielement regression analysis.Results:(1)Among the familial patients,there were 23 cases with the parent-offspring relationship,accounting for 15.97%;and 112 cases had the sibling relationship,accounting for 77.78%;and 6.25%(9 cases) of the FNMTC exhibited a parent-offspring and sibling relationship;(2)There were significant differences between the FNMTC group and the sporadic group in terms of tumor multicentricity(59.7% vs 48.2%),tumor bilaterality(41.7%vs 33.2%),lymph node metastasis(50.7% vs 40.1%) and central lymph node metastasis(50.7% vs 39%)(P<0.05 for all);(3)Compared with the sporadic thyroid microcarcinoma group,the familial non-medullary thyroid microcarcinoma group was more frequently with multicentricity(56.4% vs 46.1%) and a higher rate of lymph node metastasis(42.7% vs 30.6%) and central lymph node metastasis(42.7% vs 29.9%)(P < 0.05 for all);(4)The age of the parent-offspring group was younger than that of the sibling group(P<0.05);(5)Compared with the sporadic group, the parent-offspring FNMTC exhibited with younger diagnosed age(73.9% vs 50.7%),tumor multicentricity(69.6%vs48.2%),tumor bilaterality(56.5%vs 33.2%),lymph node metastasis(60.9%vs40.1%) and central lymph node metastasis(60.9% vs 39%)(P<0.05 for all), while the sporadic group had more patients with extrathyroidal invasion than the sibling FNMTC(68.3% vs 58.9%);(6) Among the parent-offspring FNMTC, patients in the second generation presented with earlier diagnosed age(25% vs 100%),higher rate of lymph node metastasis(25% vs 80%) and central lymph node metastasis(25% vs 80%(P<0.05 for all)than the first generation;(7)The single factor analysis showed that age,multifocality,tumor bilaterality,capsular invasion and tumor size were significantly correlated to central lymph node metastasis in familial non-medullary thtroid carcinoma;(8)Through the multielement regression analysis,it was clear that age,capsular invasion and tumor size presented with statistically significant difference.Conclusions:(1)FNMTC presented with much more aggressiveness and clinical treatment should be aggressive.We recommended bilateral thyroidectomy and central lymph node dissection be the routine operation.(2)Also we found that the familial non-medullary microcarcinoma was more aggressive thus much more attention should be paid to.(3) Compared with the sporadic group, the parent-offspring FNMTC presented with younger diagnosed age,more tumor multicentricity and tumor bilaterality,higher rate of lymph node metastasis and central lymph node metastasis;besides,patients in the second generation presented with earlier diagnosed age,higher rate of lymph node metastasis especially central lymph node metastasis than the first generation.(4)Age smaller than 45 years,capsular invasion and tumor diameter more than 1cm could be taken as the risk factors of central lymph node metastasis in familial non-medullary thtroid carcinoma,so much more attention should be paid to.