【摘要】 目的:探讨甲状腺乳头状微小癌(PTMC)发生淋巴结转移(LNM)的影响因素。方法:收集535例行甲状腺切除术且病理证实为PTMC患者的临床资料，比较PTMC患者中有和无淋巴结转移、不同转移区域、不同肿瘤直径组间临床病理特征，分析淋巴结转移与临床病理特征的相关性。结果:PTMC合并淋巴结转移组192例(35.89%),非淋巴结转移组343例(64.11%),两组比较，淋巴结转移组年龄<55岁、男性、癌灶多发、双侧分布、直径>0.5 cm、合并桥本氏甲状腺炎(HT)、中/高危复发危险分层比例显著升高，差异均有统计学意义(均P<0.05);中央区淋巴结转移(CLNM)组147例(76.56%),颈侧区淋巴结转移(LLNM)组45例(23.44%),与CLNM组比较：LLNM组癌灶多发、双侧分布、合并HT比例升高，BRAF基因突变率比例降低，差异均有统计学意义(均P<0.05);肿瘤直径≤0.5 cm组187例(34.95%),直径>0.5 cm组348例(65.05%),与直径≤0.5 cm组比较：直径>0.5 cm组癌灶多发、双侧分布、合并LNM、包膜外侵犯、中/高危复发危险分层比例升高，差异均有统计学意义(均P<0.05);多因素Logistics回归分析显示年龄<55岁、男性、癌灶多发、直径>0.5 cm、合并HT是LNM的独立危险因素(均P<0.05)。结论:年龄<55岁、男性、癌灶多发、直径>0.5 cm、合并HT是PTMC淋巴结转移的独立危险因素，颈部淋巴结转移增加PTMC复发风险。更多还原

【Abstract】 Objective:To investigate the influencing factors of lymph node metastasis(LNM) in papillary thyroid microcarcinoma(PTMC).Methods:Clinical data of 535 patients with thyroidectomy and pathologically confirmed PTMC were analyzed to compare the clinicopathological characteristics of PTMC patients with lymph node metastasis and non-lymph node metastasis, different metastatic regions, different tumor diameter, and further analyze the correlation between lymph node metastasis and PTMC clinicopathological characteristics.Results:There were 192 patients(35.89%) in the PTMC combined with lymph node metastasis group and 343 patients(64.11%) in the non-lymph node metastasis group.The proportion of age<55 years, male, multiple foci, bilateral distribution, >0.5 cm indiameter,Hashimoto’s thyroiditis( HT),and medium/high-risk recurrence in lymph node metastasis group were significantly higher( all P < 0. 05). There were 147 patients( 76. 56%) in the central lymph node metastasis( CLNM)group,and 45 cases( 23. 44%) in the lateral lymph node metastasis( LLNM) group. Compared with the CLNM group,the proportion of multiple foci,bilateral distribution,HT were higher,the proportion of BRAF mutation was lower in the LLNM group( all P < 0. 05). There were 187 cases( 34. 95%) in the group of ≤0. 5 cm in diameter and348 cases( 65. 05%) in the group of > 0. 5 cm in diameter. Compared with the group of ≤0. 5 cm,the proportion of multiple foci,bilateral distribution,lymph node metastasis,extra-capsular invasion,and medium/high risk recurrence were significantly higher in the group of > 0. 5 cm in diameter( all P < 0. 05). Logistic regression analysis showed that age < 55,male,multiple foci,> 0. 5 cm in diameter,and HT were risk factors of lymph node metastasis( all P <0. 05). Conclusion: Age < 55 years,male,multiple foci,> 0. 5 cm in diameter,and HT were independent risk factors for PTMC lymph node metastasis,and lymph node metastasis increases the risk of PTMC recurrence.更多还原