Analysis Of Papillary Thyroid Carcinoma In Clinical Epidemiology And Pathological Features

OBJECTIVE:To analyze the clinical epidemiology and pathological features of papillary thyroid carcinoma,especially the multifocal papillary thyroid carcinoma and bilateral papillary thyroid carcinoma,through retrospective analysis of the cases in Qilu Hospital in nearly 10 years.And then explore the risk factors for lymph node metastasis to provide clinical basis for the prevention,early diagnosis and initial treatment of the tumor.METHODS:This study consists of two parts.In the first part,we reviewed the information of the thyroid nodule patients in Qilu Hospital during January 2006 to December 2015.The papillary thyroid carcinoma epidemiology characteristics of the number of patients,sex ratio,age structure and pathological data were analyzed.In the second part,analyzed the 3725 papillary thyroid carcinoma cases and summarized the features of the multifocal carcinoma and bilateral carcinoma by comparing respectively.Then we analyzed the effects of multifocality and bilaterality on lymph node metastasis of papillary carcinoma through multiple regression analysis.RESULTS:1.In 7746 thyroid nodule patients,there were 3950 thyroid carcinoma patients.And there were 3725 papillary thyroid carcinoma patients,which accounted for 94.30%.The number of patients PTC admitted to Qilu Hospital significantly increased in the past 10 years,and the proportion of papillary microcarcinoma showed a rising trend.The ratio of male to female was 1:3.1,and there was no change in sex ratio in 10 years.Both men and women were at a high incidence of 35~55 years old.Patients with nodular goiter(37.2%)and Hashimoto's thyroiditis(14.7%)respectively showed a decreasing trend and no change.The incidence of multifocal carcinoma was 29.6%with no change in recent 5 years.And the incidence of bilateral cancer was 19.8%with a decreasing trend.2.Compared with the patients suffered solitary carcinoma,the individuals with multifocal carcinoma were older,with larger diameter of the tumor,and more prone to lymph node metastasis and capsule invasion.The proportion of papillary microcarcinoma,patients with nodular goiter and patients with adenoma were less.Then,compared with the patients with solitary carcinoma,the individuals with unilateral-multifocal carcinoma were with larger diameters,more prone to lymph node metastasis and nodular goiter,less microcarcinoma,but no difference in the capsular invasion rate.3.Compared with the patients suffered unilateral cancer,the ones with bilateral cancer were older,more in women,with larger diameter of the tumor,and more prone to lymph node metastasis and capsule invasion.The proportion of papillary microcarcinoma,patients with nodular goiter and patients with adenoma were less.Then,compared with the patients with unilateral-multifocal carcinoma,the individuals with bilateral carcinoma were with larger diameters,less microcarcinoma,but no difference in the rate of lymph node metastasis and capsular invasion.4.In the univariate analysis,patients were more prone to lymph node metastasis(P<0.05)who were male,aged less than 45,with multifocality,bilaterality,larger tumor diameter,as well as capsular invasion.However lymph metastasis occurred less in the ones with Hashimoto's thyroiditis and nodular goiter(P<0.05).Further analysis of multiple factors,multifocality,bilaterality and Hashimoto's thyroiditis were not independent factors for lymph node metastasis.CONCLUSION:1.The proportion of thyroid carcinoma in thyroid nodules in Qilu hospital has been increased significantly in 10 years.The number of Papillary thyroid carcinoma patients showed an obviously increasing trend in the past 10 years,especially the microcarcinoma.2.There was no difference in the incidence and age of papillary thyroid carcinoma between males and females.3.In the past 5 years,the detection rate of unilateral PTC,especially unilateral MPTC was increased year by year.4.Multifocal carcinoma and bilateral carcinoma were more aggressive,which showed higher incidence of lymph node metastasis and capsule invasion.5.Multifocality,bilaterality and Hashimoto's thyroiditis were related to the lymph node metastasis rate of papillary carcinoma,but they were not independent factors.The independent factors of lymph node metastasis included age,sex,tumor size,capsule invasion and nodular goiter.