基于不同肿瘤位置分型的甲状腺乳头状癌Ⅱ、Ⅳ区淋巴结转移危险因素分析

Risk factors for level Ⅱ and level IV lymph node metastasis in papillary thyroid carcinoma based on different tumor location classifications

摘要

目的: 探讨甲状腺乳头状癌(papillary thyroid carcinoma，PTC)患者Ⅱ区及Ⅳ区淋巴结转移的危险因素，并比较不同肿瘤位置分型方法在预测侧颈区不同分区淋巴结转移中的价值，为术前淋巴结转移评估及手术清扫范围的制定提供参考依据。方法: 回顾性分析2022年1月1日—2025年5月1日于江苏省江原医院接受手术治疗的PTC患者临床及病理资料。通过单因素及多因素Logistic回归分析肿瘤位置与Ⅱ区及Ⅳ区淋巴结转移的相关因素，采用受试者工作特征(receiver operating characteristic，ROC)曲线比较不同肿瘤位置分型方法对Ⅱ区及Ⅳ区淋巴结转移的预测效能。结果: 共纳入152例PTC患者，其中Ⅱ区淋巴结转移59例(38.82%)，Ⅳ区淋巴结转移113例(73.34%)。单因素分析结果显示，肿瘤位置与Ⅱ区及Ⅳ区淋巴结转移均存在显著相关性(P<0.05)，多因素分析结果显示，传统法及中静脉分界法区分肿瘤位置是Ⅱ区淋巴结转移的独立影响因素，中静脉分界法区分肿瘤位置及Ⅵ区淋巴结是否转移为Ⅳ区淋巴结转移的独立影响因素。ROC曲线分析显示，中静脉分界法预测Ⅱ区淋巴结转移的曲线下面积(area under the curve，AUC)为0.749，高于传统分区方法(AUC为0.608)，差异具有统计学意义(P<0.05)；预测Ⅳ区淋巴结转移的AUC分别为0.687和0.650，差异没有统计学意义，提示以中静脉为解剖标志的肿瘤位置分型在预测Ⅱ区淋巴结转移方面具有更好的诊断效能。结论: PTC患者Ⅱ区及Ⅳ区淋巴结转移与肿瘤位置密切相关。相比传统纵轴三等分法，以甲状腺中静脉为解剖标志的肿瘤位置分型有助于提高侧颈区淋巴结转移风险的识别能力，为侧颈区淋巴结清扫范围的个体化制定提供参考。

Abstract

Objective: To identify risk factors for level Ⅱ and level Ⅳ lymph node metastasis in papillary thyroid carcinoma(PTC)and to evaluate the predictive value of different tumor location classification methods. Methods: A retrospective analysis was performed on PTC patients who underwent thyroid surgery between January 2022 and May 2025. Clinical and pathological variables were collected. Tumor location was classified using the conventional longitudinal trisection method and a middle thyroid vein-based method on preoperative contrast-enhanced CT images. Univariate and multivariate logistic regression were used to analyze factors related to level Ⅱ and Ⅳ lymph node metastasis，and ROC curves were used to compare the predictive ability of different tumor location classifications. Results: Among 152 patients，59(38.82%)had level Ⅱ lymph node metastasis and 113(73.34%)had level Ⅳ lymph node metastasis. Univariate analysis revealed that tumor location was significantly associated with metastasis in both levels(P<0.05). Multivariate analysis showed tumor location(conventional or middle vein-based)independently predicted level Ⅱ metastasis，while middle vein-based location and level Ⅵ metastasis independently predicted level Ⅳ metastasis. ROC analysis showed that the middle vein-based classification had a higher AUC for predicting level Ⅱ metastasis than the traditional method(0.749 vs. 0.608，P<0.05). For level Ⅳ，the AUCs were 0.687 and 0.650. This indicates better performance for predicting level Ⅱ metastasis. Conclusion: Tumor location is closely associated with level Ⅱ and level Ⅳ lymph node metastasis in PTC. The middle thyroid vein-based classification may improve preoperative risk assessment of lateral cervical lymph node metastasis.

关键词

甲状腺乳头状癌 / 肿瘤位置分型 / 中静脉 / 侧颈区淋巴结转移

Key words

papillary thyroid carcinoma / tumor location classification / middle thyroid vein / lateral cervical lymph node metastasis

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基金资助

江苏省医学重点学科(实验室)基金(ZDXYS202211)