术前超声参数与甲状腺乳头状癌颈部淋巴结转移风险的相关性

李丹; 吴万波; 沈思平; 姚黎丽; 杨骏宇; 阳建军

doi:10.16766/j.cnki.issn.1674-4152.003037

术前超声参数与甲状腺乳头状癌颈部淋巴结转移风险的相关性

doi: 10.16766/j.cnki.issn.1674-4152.003037

湖州市中心医院超声科，浙江湖州 313000

基金项目:

浙江省医药卫生科技计划项目 2021KY1090

详细信息

通讯作者:
杨骏宇，E-mail：422787473@qq.com

中图分类号: R730.41 R736.1
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- 文章访问数: 97
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- 被引次数: 0
出版历程
- 收稿日期: 2023-02-17
- 网络出版日期: 2023-08-26

Correlation between preoperative ultrasound parameters and the risk of cervical lymph node metastasis in papillary thyroid cancer

Department of Ultrasound, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China

摘要

摘要: 目的探讨术前超声参数与甲状腺乳头状癌(papillary thyroid carcinoma，PTC)颈部淋巴结转移风险间的关系，为临床治疗决策的拟定及预后评估提供依据。方法选择2021年6月—2022年6月湖州市中心医院接受手术治疗的PTC患者148例为研究对象，根据颈部淋巴结转移情况分为转移组(59例)和非转移组(89例)。对比2组患者一般资料，术前常规超声参数(肿瘤最大径、边界、形态、距被膜距离等)，采用Pearson相关性分析PTC超声声像图特征与颈部淋巴结转移的关系；采用多因素logistic回归分析研究PTC颈部淋巴结转移的影响因素。结果转移组微钙化、距被膜距离＜1 mm、肿瘤最大径>7 mm占比较非转移组多(P < 0.05)；Pearson相关性分析显示，颈部淋巴结转移与微钙化(r=0.227，P < 0.05)、距被膜距离(r=0.293，P < 0.05)、肿瘤最大径(r=0.360，P < 0.05)呈正相关关系；多因素logistic回归分析显示：微钙化(OR=2.601，95% CI：1.049~6.452)、距被膜距离＜1 mm(OR=2.955，95% CI：1.102~7.922)、肿瘤最大径>7 mm(OR=2.965，95% CI：1.095~8.031)为PTC颈部淋巴结转移的危险因素(均P < 0.05)。结论微钙化的出现、距被膜距离＜1 mm、肿瘤最大径>7 mm超声参数提示PTC可能存在颈部淋巴结转移风险。
- 超声参数 /
- 甲状腺乳头状癌 /
- 颈部淋巴结转移 /
- 相关性
Abstract: Objective To investigate the relationship between preoperative ultrasonography parameters and the risk of cervical lymph node metastasis in papillary thyroid carcinoma (PTC), in order to provide evidence for clinical treatment and prognosis evaluation. Methods A total of 148 patients with PTC who received surgical treatment in Huzhou Central Hospital from June 2021 to June 2022 were selected as subjects, and were divided into metastatic group (59 cases) and non-metastatic group (89 cases) according to cervical lymph node metastasis. The general data and preoperative conventional ultrasound parameters (tumor maximum diameter, boundary, morphology, distance from capsule, etc.) were compared between the two groups. Pearson correlation was used to analyze the correlation between PTC ultrasound image features and cervical lymph node metastasis. Multivariate logistic regression was used to analyze the influencing factors of cervical lymph node metastasis of PTC. Results The micro-calcification, distance from the capsule < 1 mm, and the maximum diameter of the tumor >7 mm in the metastatic group were more than those in the non-metastatic group (P < 0.05). Pearson correlation analysis showed that cervical lymph node metastasis was positively correlated with micro-calcification (r=0.227, P < 0.05), distance from capsule (r=0.293, P < 0.05), and maximum tumor diameter (r=0.360, P < 0.05). Multivariate logistic regression analysis showed that micro-calcification (OR=2.601, 95% CI: 1.049-6.452), distance from capsule < 1 mm (OR=2.955, 95% CI: 1.102-7.922), and the largest tumor diameter >7 mm (OR=2.965, 95% CI: 1.095-8.031) were risk factors for cervical lymph node metastasis in PTC (all P < 0.05). Conclusion The appearance of micro-calcification, distance from the capsule < 1 mm, and maximum diameter of the tumor > 7 mm suggest that PTC may have the risk of cervical lymph node metastasis.
- Ultrasound parameters /
- Papillary thyroid carcinoma /
- Cervical lymph node metastasis /
- Correlation

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表 1 2组甲状腺乳头状癌患者一般资料比较

Table 1. Comparison of general data between two groups of patients with thyroid papillary carcinoma

组别	例数	性别(例)		年龄 (x±s，岁)	病程 (x±s，年)	吸烟 [例(%)]	甲状腺癌家族史 [例(%)]	合并桥本甲状腺炎[例(%)]
组别	例数	男性	女性	年龄 (x±s，岁)	病程 (x±s，年)	吸烟 [例(%)]	甲状腺癌家族史 [例(%)]	合并桥本甲状腺炎[例(%)]
转移组	59	22	37	49.96±7.84	4.65±1.02	17(28.81)	9(15.25)	6(10.17)
非转移组	89	38	51	48.77±8.02	4.71±1.06	29(32.58)	12(13.48)	10(11.24)
统计量		0.431^a		0.896^b	0.345^b	0.236^a	0.091^a	0.042^a
P值		0.512		0.372	0.731	0.627	0.762	0.838
注：^a为χ²值，^b为t值。

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表 2 2组甲状腺乳头状癌患者术前超声参数比较[例(%)]

Table 2. Comparison of preoperative ultrasound parameters between two groups of patients with papillary thyroid carcinoma [cases (%)]

项目	类别	转移组 (59例)	非转移组 (89例)	χ²值	P值
肿瘤最大径	>7 mm	24(40.68)	9(10.11)	19.132	< 0.001
	≤7 mm	35(59.32)	80(89.89)
边界	清晰	26(44.07)	31(34.83)	1.278	0.258
	欠清晰	33(55.93)	58(65.17)
纵横比	<1	26(44.07)	37(41.57)	0.090	0.764
	≥1	33(55.93)	52(58.43)
微钙化	有	22(37.29)	12(13.48)	11.362	< 0.001
	无	37(62.71)	77(86.52)
形态	不规则	22(37.29)	27(30.34)	0.774	0.379
	规则	37(62.71)	62(69.66)
回声质地	均匀	35(59.32)	60(67.42)	1.011	0.315
	不均匀	24(40.68)	29(32.58)
距被膜距离	距包膜≥1 mm	39(66.10)	80(89.89)	12.741	< 0.001
	距包膜＜1 mm	20(33.90)	9(10.11)

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表 3 术前超声参数与PTC颈部淋巴结转移的相关性

Table 3. Correlation between preoperative ultrasound parameters and PTC cervical lymph node metastasis

变量	颈部淋巴结转移	微钙化	距被膜距离	肿瘤最大径
颈部淋巴结转移	1
微钙化	0.227^a	1
距被膜距离	0.293^a	0.095	1
肿瘤最大径	0.360^a	0.402	0.431	1
注：^aP < 0.05。

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表 4 PTC颈部淋巴结转移影响因素多因素logistic分析

Table 4. Multivariate logistic analysis of influencing factors of PTC cervical lymph node metastasis

变量	β	SE	Waldχ²	P值	OR值	95% CI
微钙化	0.956	0.464	4.253	0.039	2.601	1.049~6.452
距被膜距离	1.084	0.503	4.639	0.031	2.955	1.102~7.922
肿瘤最大径	1.087	0.508	4.572	0.032	2.965	1.095~8.031

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