Objective: To investigate the related factors for lymph node metastasis (LNM), especially for high volume LNM (>5 metastatic lymph nodes) in papillary thyroid carcinoma (PTC). Methods: The medical records of 2 073 consecutive PTC patients who underwent lobectomy, near-total thyroidectomy or total thyroidectomy with ipsilateral or bilateral central lymph node dissection in Department of General Surgery, Peking Union Medical College Hospital from November 2013 to October 2014 were reviewed. Clinical and pathological features were collected. Univariate and multivariate analysis were performed to identify the related factors for LNM/high volume LNM. Results: In all 2 073 patients, LNM and high volume LNM were confirmed in 936 (45.15%) cases and 254 (12.25%) cases respectively. In univariate analysis, large tumor size, young patients (<40 years), male were associated with both LNM and high volume LNM. In multivariate analysis, tumor size >2.0 cm, young patients (<40 years), male were independent related factors of LNM (OR=5.262, 95% CI: 3.468 to 7.986; OR=2.447, 95% CI: 2.000 to 2.995; OR=1.988, 95% CI: 1.593 to 2.480, respectively, all P=0.000) and high volume LNM (OR=6.687, 95% CI: 4.477 to 9.986; OR=2.975, 95% CI: 2.224 to 3.980; OR=2.354, 95% CI: 1.737 to 3.191, respectively, all P=0.000). In 1 414 PTMC patients, a similar result was also demonstrated.Compared with young patients (<40 years), old patients (≥60 years) had lower incidence of LNM (25.47% vs. 52.24%, χ(2)=62.903, P=0.000) and high volume LNM (1.89% vs. 13.18%, χ(2)=37.341, P=0.000). Additionally, old patients also had lower risk of both LNM (OR=0.316, 95% CI: 0.194 to 0.517, P=0.000) and high volume LNM (OR=0.142, 95% CI: 0.034 to 0.599, P=0.000). Conclusions: The tumor size was the main related factor for both LNM and high volume LNM in PTC. The treatment should be more active in patients with tumor size >2 cm with consideration of higher incidence and risk for LNM and high volume LNM. Young patient was another important related factor for LNM and high volume LNM. In PTMC, old patients had lower incidence and risk for both LNM and high volume LNM. Dynamic observation or less surgical extent could be an option for these patients.
目的： 探讨乳头状甲状腺癌(PTC)患者淋巴结转移、大量淋巴结转移(转移淋巴结>5枚)的相关因素。 方法： 回顾性分析2013年11月至2014年10月在北京协和医院基本外科接受手术治疗并经病理学检查确诊的2 073例PTC患者的临床病理资料，通过单因素分析(χ(2)检验)、多因素分析(Logistic回归)确定PTC患者淋巴结转移、大量淋巴结转移的相关因素。 结果： 在2 073例PTC患者中，淋巴结转移者936例(45.15%)，大量淋巴结转移者254例(12.25%)。2 073例PTC患者淋巴结转移单因素分析结果显示，随肿瘤最大径的增加(≤1.0 cm、1.1～2.0 cm和>2.0 cm)，PTC患者更易出现淋巴结转移(36.28%、59.12%和80.0%，χ(2)＝162.702，P＝0.000)、大量淋巴结转移(6.79%、18.44%和41.25%，χ(2)＝182.138，P＝0.000)；年龄<40岁较年龄≥40岁、男性较女性患者有明显升高的淋巴结转移率(60.56%比37.68%、58.37%比41.06%，χ(2)为96.390、45.252，P＝0.000)、大量淋巴结转移率(21.27%比7.88%、20.20%比9.79%，χ(2)为76.034、37.733，P＝0.000)。多因素分析结果显示，最大径>2.0 cm、年龄<40岁、男性是PTC患者出现淋巴结转移(OR＝5.262，95% CI：3.468～7.986；OR＝2.447，95% CI：2.000～2.995；OR＝1.988，95% CI：1.593～2.480)、大量淋巴结转移(OR＝6.687，95% CI：4.477～9.986；OR＝2.975，95% CI：2.224～3.980；OR＝2.354，95% CI：1.737～3.191)的相关因素(P值均＝0.000)。1 414例乳头状甲状腺微小癌(PTMC)患者亦有相似的淋巴结转移、大量淋巴结转移的相关因素分析结果；≥60岁较<40岁患者的淋巴结转移率(25.47%比52.24%，χ(2)＝62.903，P＝0.000)、大量淋巴结转移率(1.89%比13.18%，χ(2)＝37.341，P＝0.000)下降，多因素分析结果显示其出现淋巴结转移(OR＝0.316，95% CI：0.194～0.517)、大量淋巴结转移(OR＝0.142，95% CI：0.034～0.599)的风险降低(P＝0.000)。 结论： 肿瘤大小是PTC患者出现淋巴结转移、大量淋巴结转移风险最高的相关因素，肿瘤最大径>2.0 cm的患者淋巴结转移率、大量淋巴结转移率和转移风险高，应给予积极治疗。其次的相关因素是患者年龄<40岁。60岁以上的PTMC患者，淋巴结转移、大量淋巴结转移的风险较低，可以观察随访。.
Keywords: Factor analysis, statistical; Lymphatic metastasis; Thyroid neoplasms.