| Thyroid carcinoma is the most common malignant tumor of endocrine system,which is about 0.2~1.0% of all malignant tumors.Most thyroid carcinoma come from follicular epithelial cells except medullary carcinoma.The incidence of thyroid carcinoma is related to region,race and gender,the incidence of thyroid carcinoma is increasing sharply.Among them,thyroid papillary carcinoma(PTC)accounted for about 85% of the total number of thyroid carcinoma.PTC with a tumor diameter of less than 1cm is defined as papillary microcarcinoma(PTMC).Although most of the patients with PTMC have well prognosis,there are also some patients may appear early cervical lymph node metastasis,the central lymph nodes were infected most commonly,which is one of the risk factors of PTMC local recurrence.Thyroidectomy +central district lymph nodes dissection are the best treatments for most PTMC patients,but that demand professional surgery skills.The purpose of this study was to find out the risk factors of CLNM in PTMC,and the results would help to select the appropriate patients for the central district lymph nodes dissection.Objective: PTMC patients with CLNM have a higher recurrent rate and lower survival rate than who without CLNM.Imaging examinations have deficiencies,there were about 28%-32% of PTMC patients had negative cervical lymph nodes metastasis.So preventive central compartmentlymph nodes dissection was recommended by guideline of CTA 2012.But it needs professional surgery skills.This study chooses the patients from January 1,2016-December 31,2017 in the second hospital of Jilin university who undergone with thyroid dissection and central compartment dissection,as objections of this study.To summarize the clinical risk factors related to lymph node metastasis in the central compartment of PTMC,to guide the operation,improve the prognosis of patients and reduce the risk of recurrence.Methods: This study chooses on the patients from January 1,2016-December 31,2017 in the second hospital of Jilin university thyroid who undergone unilateral thyroid globe dissection and total thyroid dissection first time and proved as PTMC by intraoperative pathology,then undergone a preventive central lymph nodes dissection.But except that secondary thyroid carcinoma,patient has PTMC and other types of thyroid carcinoma(MTC?FTC?ATC),diameter of focus more than 1cm.Prediction variables(related clinical risk factors)include: 1.Age 2.Gender 3.Tumor size(the maximum size of tumor diameter)4.multiple focus 5.With or without thyroiditis.Statistical methods: correlation analysis of lymph node metastasis in the central compartment lymph node of PTMC and various clinical factors: using SPSS22.0 for statistical analysis of variables.1.Metering data: the mean value of the measurement data is expressed in the mean and/or standard deviation(?X±SD),and the two mean values are compared with the t-test(including the calculation of 95% confidence interval),and the rank sum test is adopted when the variance is not homogeneous.2.Counting data: the counting data is tested by ?2.3.Analysis of the influencing factors of lymph node metastasis in PTMC: the analysis of the relationship betweenlymph node metastasis and clinical risk factors related to PTMC central region and Logistic regression analysis.Results: 1.Epidemiological characteristics of lymph node metastasis in the central region of PTMC.This study investigated 297 patients diagnosed with PTMC,aged 22-76 years.The incidence of CLNM was 22.2%(66 cases in total).Among them,there are more female(48 cases,72.7%)than male(18 cases,27.3%);More cases with the age?45(40 cases,60.6%)than the age<45(26 cases,39.4%);Most of the cases with the tumor diameter over 5mm(45 cases,68.2%),and the minor diameter was 5mm(21 cases,31.8%);Mostly involved in a single lymph node metastasis(47 cases,71.2%),some involving 2(14 cases,21.2)%= or more lymph nodes(5 cases,7.6%);single lesions(42 cases,63.6%)were the most common,followed by 2 lesions(14 cases,21.2%),3 lesions(6 cases,9.1%),more than 3 lesions(4 cases,6.1%);tumor involving unilateral lobes(51 cases,77.3%),and some bilateral glands were involved(15 cases,22.7%);most without thyroiditis(57 cases,86.4%),and only a few were associated with Hashimoto's thyroiditis(7 cases,10.6%)or subacute thyroiditis(2 cases,3.0%).2.Analysis of Clinical Factors Related to Central Lymph Node Metastasis in PTMC.(1)Univariate analysis: There was a significant difference in the distribution of gender,age,and tumor diameter between the central lymph node metastasis group and the non-central lymph node metastasis group of the PTMC(p<0.05).The multiple lesions or thyroiditis had no significant difference between the groups(p>0.05),and there was no statistical significance.(2)Logistic multivariate regression analysis of binary variables: Clinical risk factors for central lymph node metastasis in PTMC patients were gender(male),age(<45years),and tumor diameter(>5mm),which were the independent clinical risk factors for central lymph node metastasis... |
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