Risk Factors Analysis For Central Lymph Node Metastasis Of Papillary Thyroid Microcarcinoma In Patients Over 60

Objective:Because of decreasing metabolism and chronic,occult disease,the thyroid papillary microcarcinoma(PTMC)patients over 60 years old always have a poor tolerance to surgery,so operating central lymph node metastasis is harm to surgery.There is a large difference all over the world about weather should operate central lymph node metastasis in these patients.This study aims to research the risk factors for central lymph node metastasis of PTMC in patients aged over 60 years to provided reference for doctors to develop the treatment and prognosis.Methods:The clinical data of PTMC patients at the age of more than 60 years old admitted in the Second Hospital of Jilin University from Oct.2014 to Dec.2016 was retrospectively input.All patients matched the inclusion criteria were selected,and their operational manner were determined by ultrasound,fine needle aspiration and the Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer(2012 Chinese edition).Some clinical information were collected and recorded,such as age,sex,tumor size,capsule invasion,multifocality,thyroiditis and thyroid-stimulating hormone(TSH)before operation.The correlation of central lymph node metastasis with these factors were analyzed by univariate analyses(?2test).The independent risk factors of central lymph node metastasis of papillary thyroid microcarcinoma in patients over 60 were determined by multivariate analyses(Logistic regression).Results:The age of all the PTMC patients ranges from 60 to 79 years old,average age is 66.9±5.3 years old.Male is 21 and female is 84.Tumor diameter ranges from 1 to 10 mm,average diameter is5.5±2.1mm.Patients with single tumor is 63,and multiple tumor is 42.Patients with capsule invasion is 29,and without capsule invasion is 76.Unilateral tumor is 71 and bilateral tumor is 34.There are 7 patients have a decreased TSH before operation,the others are normal.And 16 patients suffer from thyroiditis at the same time.The rate of central lymph node metastasis in elder PTMC was 32.4%(34/105).Univariate analysis showed that the central lymph node metastasis was correlated with tumor size,capsule invasion,multifocality,rather than age,sex and the other factors.Multivariate analysis showed that tumor diameter >5mm(P < 0.01),capsule invasion(P < 0.05),multifocality(P < 0.01)were associated with central lymph node metastasis of PTMC patients over 60,but age and sex are not included.And the metastasis rate in patients with risk factor was obviously higher than without any(P <0.05).Conclusions:Independent factors predictive of central lymph node metastasis in PTMC patients over 60 are tumor size,capsule invasion,multifocality.Age and sex are not included.In the clinic,it is necessary for the patients with risk factors(tumor diameter > 5mm,capsule invasion,multifocality)to clear the central lymph node.For the other patients without risk factors,weather operating lymph nodedissection should depend on physical condition.As a special group,PTMC patients over 60 years old always have a poor tolerance to surgery.Therefore,more excellent individualized treatments are needed,not only removing primary lesion,but also developing patients' quality of life.