CAJ | 학술논문

目的探讨甲状腺髓样癌患者颈部淋巴结转移规律.方法回顾性分析1999年1月至2014年10月初治的甲状腺髓样癌91例患者临床资料,其中临床淋巴结阴性(cN0) 39例,临床淋巴结阳性(cN+)52例.91例均行中央区淋巴清扫,52例cN+患者共行71侧颈部淋巴清扫.按颈部分区计数淋巴结数目,研究cN+甲状腺髓样癌患者颈部淋巴结转移规律,以及性别、年龄、髓样癌家族史、原发肿瘤大小、双侧癌灶、多癌灶、被膜侵犯及远处转移等因素与中央区淋巴转移的关系.影响淋巴转移率的单因素差异比较采用x2检验,采用Logistic模型进行多因素分析.结果本组甲状腺髓样癌患者颈部淋巴结转移率73.6％ (67/91),双侧颈淋巴结转移率19.8％(18/91);中央区淋巴结转移率68.1％(62/91),其中cN0患者33.3％(13/39),cN+患者94.2％ (49/52);上纵隔淋巴结转移率27.5％(25/91),其中cN0患者2.6％(1/39),cN+患者46.2％(24/52).影响中央区淋巴转移的独立危险因素是甲状腺被膜受侵犯(x2=15.592,P=0.000,OR=12.876).cN+甲状腺髓样癌患者颈部淋巴结转移各区转移为Ⅱ区62.9％(44/70)、Ⅲ区84.5％(60/71)、Ⅳ区83.1％ (59/71),Ⅴ区50.0％ (32/64),以多个分区转移为主.术前检测降钙素水平的47例患者中,33例术前降钙素＞300 ng/L,侧颈淋巴结转移率为66.7％ (22/33),较降钙素＜300 ng/L侧颈淋巴结转移率28.6％(4/14)的14例患者增高,两组差异有统计学意义(x2=5.771,P=0.016).结论甲状腺髓样癌的颈部淋巴结转移率高,对于cN0被膜受侵患者需要清扫中央区淋巴结.对于cN+患者建议清扫同侧Ⅱ-Ⅶ区淋巴结.术前检查降钙素可用来初步预测颈侧淋巴结转移情况.
목적 탐토갑상선수양암환자경부림파결전이규률.방법 회고성분석1999년1월지2014년10월초치적갑상선수양암91례환자림상자료,기중림상림파결음성(cN0) 39례,림상림파결양성(cN+)52례.91례균행중앙구림파청소,52례cN+환자공행71측경부림파청소.안경부분구계수림파결수목,연구cN+갑상선수양암환자경부림파결전이규률,이급성별、년령、수양암가족사、원발종류대소、쌍측암조、다암조、피막침범급원처전이등인소여중앙구림파전이적관계.영향림파전이솔적단인소차이비교채용x2검험,채용Logistic모형진행다인소분석.결과 본조갑상선수양암환자경부림파결전이솔73.6％ (67/91),쌍측경림파결전이솔19.8％(18/91);중앙구림파결전이솔68.1％(62/91),기중cN0환자33.3％(13/39),cN+환자94.2％ (49/52);상종격림파결전이솔27.5％(25/91),기중cN0환자2.6％(1/39),cN+환자46.2％(24/52).영향중앙구림파전이적독립위험인소시갑상선피막수침범(x2=15.592,P=0.000,OR=12.876).cN+갑상선수양암환자경부림파결전이각구전이위Ⅱ구62.9％(44/70)、Ⅲ구84.5％(60/71)、Ⅳ구83.1％ (59/71),Ⅴ구50.0％ (32/64),이다개분구전이위주.술전검측강개소수평적47례환자중,33례술전강개소＞300 ng/L,측경림파결전이솔위66.7％ (22/33),교강개소＜300 ng/L측경림파결전이솔28.6％(4/14)적14례환자증고,량조차이유통계학의의(x2=5.771,P=0.016).결론 갑상선수양암적경부림파결전이솔고,대우cN0피막수침환자수요청소중앙구림파결.대우cN+환자건의청소동측Ⅱ-Ⅶ구림파결.술전검사강개소가용래초보예측경측림파결전이정황.
Objective To study the patterns of cervical lymph node metastasis of medullary thyroid carcinoma.Methods Ninety-one patients with medullary thyroid carcinoma first treated between January 1999 and October 2014 were analyzed retrospectively.Of 91 patients,39 cases presented with clinical negative node (cN0) and 52 cases with clinical positive node (cN +).Central compartment dissection was performed in all cases.Lateral neck dissection was performed in 52 cN + cases (71 sides).All neck dissection specimens were obtained and analyzed for lymph node (LN) involvement with respect to neck levels.The distribution of LN with metastasis was studied in cN + patients and the following factors were used to study the predictive value of central compartment LN metastasis:sex,age,family history,tumor size,bilateral tumor,multifocality of the tumor,extracapsular spread,and remote metastasis.Univariate analysis with the x2 test was used to analyze the statistical correlation between central compartment LN metastasis and other clinical factors.Multiple logistic regression analysis was used to identify the factors related to central compartment metastasis.Results Neck and bilateral neck metastasis rates were 73.6％,19.8％ respectively.Metastasis rates in central compartment and superior mediastinal region were 68.1％ and 27.5％ respectively.The central compartment metastasis rate was 33.3％ in cN0 patients and 94.2％ in cN + patients.The superior mediastinal metastasis rate was 2.6％ in cN0 patients and 46.2％ in cN + patients.Extracapsular spread was an independent predictive factor for central compartment metastasis (x2 =15.592,P =0.000,OR =12.876).The incidences of LN metastases at level Ⅱ,Ⅲ,Ⅴ were 62.9％,84.5％,83.1％,50.0％ in cN + patient,respectively.Multi-sites were involved.The possibility of lateral neck metastasis was higher when preoperative value of calcitonin was higher than 300 ng/L (66.7％ vs 28.6％,x2 =5.771,P =0.016).Conclusions Cervical lymph node metastasis of medullary thyroid carcinoma is higher.Central compartment dissection is necessary in cN0 patients with extracapsular spread.Neck dissection from level Ⅱ to level Ⅶ was necessary in cN + patients.Preoperative value of calcitonin maybe can predict the lateral neck metastasis incidence.