【摘要】 目的：探讨甲状腺乳头状癌（PTC）患者发生颈部淋巴结转移或肿瘤突破甲状腺被膜的相关因素，为临床早期诊断和精准治疗提供依据。方法：回顾性分析206例于2019年6月—2020年6月在中日友好医院经甲状腺穿刺病理确诊恶性并行手术治疗的PTC患者，按术后病理分为颈部淋巴结转移组（n=74）与未转移组（n=132），分析其临床病理特征，并通过Logistic回归分析淋巴结转移及被膜突破的危险因素。结果：单因素分析显示，年龄<45岁、超声下甲状腺结节最大径≥1cm、形态不规则、有钙化及淋巴结形态异常在淋巴结转移组占比更高，差异有统计学意义（P<0.05）。Logistic回归分析显示年龄<45岁（OR=2.44,95%CI:1.30～4.76）、超声下甲状腺结节最大径≥1cm(OR=2.03,95%CI:1.06～3.90)及淋巴结形态异常（OR=4.55,95%CI:1.92～11.53）与淋巴结转移风险相关，相关性均有统计学意义（P<0.05）。根据有无突破被膜分组后分析发现，淋巴结转移（OR=3.71,95%CI:1.89～7.30），及结节最大径≥1cm(OR=2.21,95%CI:1.13～4.34)与突破被膜相关，相关性有统计学意义（P<0.05）。结论：年龄<45岁、肿瘤≥1cm及超声淋巴结形态异常与PTC淋巴结转移显著相关，肿瘤大小（≥1cm）及淋巴结转移为突破被膜重要影响因素，可为手术范围及预后评估提供参考。更多还原

【Abstract】 Objective:To investigate the factors associated with cervical lymph node metastasis or tumor invasion beyond the thyroid capsule in patients with papillary thyroid carcinoma(PTC).Methods:A retrospective analysis was conducted on 206 patients with PTC who were pathologically diagnosed as malignant by thyroid fine-needle aspiration and underwent surgical treatment at China-Japan Friendship Hospital between June 2019 and June 2020.According to postoperative pathological findings,the patients were divided into a cervical lymph node metastasis group(n=74)and a non-metastasis group(n=132).Their clinicopathological characteristics were analyzed,and risk factors for lymph node metastasis and capsular invasion were determined using logistic regression analysis.Results:Logistic regression analysis revealed that age<45 years(OR=2.44,95%CI:1.30-4.76,P=0.006),maximum thyroid nodule diameter ≥1 cm on ultrasounography(OR=2.03,95%CI:1.06-3.90,P=0.032),and abnormal lymph node morphology(OR=4.55,95%CI:1.92-11.53,P=0.001)were significantly associated with an increased risk of lymph node metastasis.In subgroup analysis stratified by capsular invasion status,lymph node metastasis(OR=3.71,95%CI:1.89-7.30,P<0.001)and maximum nodule diameter≥1 cm(OR=2.21,95%CI:1.13-4.34,P=0.021)were significantly correlated with capsular invasion.Conclusion:Age<45 years,tumor size≥1 cm,and abnormal ultrasound morphology of lymph nodes are significantly associated with lymph node metastasis in PTC.Tumor size（≥1 cm）and lymph node metastasis are important influencing factors for capsular invasion,which can provide references for surgical planning and prognosis evaluation.更多还原