文章：

甲状腺微小乳头状癌高危淋巴结转移风险因素分析

Analysis of Risk Factors for High-Risk Lymph Node Metastasis in Papillary Thyroid Microcarcinoma

原文发布日期：6 August 2025

DOI: 10.3390/cancers17152585

类型: Article

开放获取: 是

英文摘要：

Background: Papillary thyroid microcarcinoma (PTMC) is associated with certain features that carry an increased risk of local recurrence, underscoring the importance of preoperative risk assessment. This study investigated the clinicopathological factors associated with high-risk lymph node metastasis (HRLNM) and patient outcomes. HRLNM is defined as ≥5 metastatic lymph nodes and/or lateral neck metastasis. Methods: We conducted a retrospective review of 985 patients with PTMC who underwent thyroidectomy at the Kaohsiung Chang Gung Memorial Hospital from 2013 to 2022. Results: Among the 985 patients, 100 (10.2%) had lymph node metastasis (LNM), and 27% of these were classified as having HRLNM. Male sex (OR 3.61,p= 0.04) and extranodal extension (OR 3.76,p= 0.043) were independent predictors of HRLNM. Patients with LNM exhibited lower rates of excellent treatment response (75% vs. 87%,p= 0.001), higher recurrence rates (9.0% vs. 0.6%,p= 0.001), and an increased risk of distant metastasis (2.0% vs. 0%). Recurrence-free survival (RFS) was significantly shorter in patients with LNM (120.9 vs. 198.6 months,p< 0.001). Although HRLNM showed a trend toward reduced RFS (113.5 vs. 124.6 months,p= 0.177), its impact on long-term survival remains uncertain. Conclusions: Male sex and extranodal extension were significant risk factors for HRLNM in patients with PTMC. These findings highlight the need for individualized risk stratification to guide treatment strategies and improve patient outcomes.

摘要翻译： 

背景：甲状腺微小乳头状癌（PTMC）具有某些增加局部复发风险的特征，这凸显了术前风险评估的重要性。本研究探讨了与高危淋巴结转移（HRLNM）相关的临床病理因素及患者预后。HRLNM定义为转移淋巴结数量≥5个和/或存在侧颈淋巴结转移。方法：我们对2013年至2022年间在高雄长庚纪念医院接受甲状腺切除术的985例PTMC患者进行了回顾性分析。结果：在985例患者中，100例（10.2%）存在淋巴结转移（LNM），其中27%被归类为HRLNM。男性（OR 3.61，p=0.04）和淋巴结外侵犯（OR 3.76，p=0.043）是HRLNM的独立预测因素。与无LNM患者相比，LNM患者的治疗反应优良率较低（75% vs. 87%，p=0.001），复发率较高（9.0% vs. 0.6%，p=0.001），且远处转移风险增加（2.0% vs. 0%）。LNM患者的无复发生存期（RFS）显著缩短（120.9个月 vs. 198.6个月，p<0.001）。尽管HRLNM显示出RFS缩短的趋势（113.5个月 vs. 124.6个月，p=0.177），但其对长期生存的影响尚不确定。结论：男性和淋巴结外侵犯是PTMC患者发生HRLNM的重要危险因素。这些发现强调了个体化风险分层的必要性，以指导治疗策略并改善患者预后。

原文链接：

Analysis of Risk Factors for High-Risk Lymph Node Metastasis in Papillary Thyroid Microcarcinoma