甲状腺微小乳头状癌中央区淋巴结转移影响因素的聚类分析研究

doi:10.3969/j.issn.1006-7795.2021.06.024

摘要/Abstract

摘要： 目的采用聚类分析方法探讨甲状腺微小乳头状癌(papillary thyroid microcarcinoma, PTMC)中央区淋巴结转移的危险因素。方法选择2015年1月至2019年6月术后病理明确诊断 PTMC 的患者481例为研究对象,回顾性分析病例资料中患者性别、年龄、肿瘤直径、肿瘤是否多发、肿瘤被膜是否受累、颈部淋巴结是否转移、是否合并其他甲状腺良性疾病等信息,将以上7个影响因素作为聚类分析的变量,通过SPSS软件根据一定的统计标准进行自动聚类得到最佳聚类结果。并进一步验证聚类分析结果,从而判断影响中央区淋巴结转移的因素。结果本研究 481例PTMC患者中男性125例、女性356例,比例为1:2.85,平均年龄(44.87±12.14)岁。207例PTMC 患者中央区淋巴结转移,转移率约为43.0%。聚类分析将PTMC患者分为3个临床类别:类别1组:所有患者均无肿瘤累及甲状腺被膜,以单发肿瘤为主,肿瘤直径均小于其他两组患者,其淋巴结转移率最低,为32.54%;类别2组:患者肿瘤直径较大,均有被膜受累,且均为单发肿瘤,其淋巴结转移率为38.61%;类别3组:患者均有甲状腺被膜受累和多发肿瘤(均达到100%),其淋巴结转移率高达57.14%。进一步采用单因素相关性分析和多因素回归分析验证聚类分析的结果,提示肿瘤大小、肿瘤数量和甲状腺被膜受累为PTMC中央区淋巴结转移的影响因素,其中甲状腺被膜受累和多发肿瘤是更重要的影响因素。结论 PTMC患者中央区淋巴结转移最为常见,肿瘤大小、肿瘤数量和甲状腺被膜受累是中央区淋巴结转移的影响因素,其中,甲状腺被膜受累和多发肿瘤对中央区淋巴结是否转移的评估作用更重要。

关键词: 甲状腺微小乳头状癌, 中央区淋巴结转移, 聚类分析

Abstract: Objective To investigate the risk factors of central lymph node metastasis in papillary thyroid microcarcinoma (PTMC) by cluster analysis. Methods Totally 481 patients diagnosed with PTMC from January 2015 to June 2019 were enrolled in this study. The clinical features including gender, age, tumor diameter, number of tumors, tumor capsule involvement, cervical lymph node metastasis and comorbid with benign thyroid diseases were analyzed by cluster analysis with SPSS software. Furthermore, validation of cluster analysis was made in order to determine the impact factors of central lymph node metastasis. Results In this study, 481 PTMC patients were involved, including 125 males and 356 females, with the average age of (44.87±12.14) years. 207 PTMC patients were with central lymph node metastasis, and the metastasis rate was about 43.0%. Cluster analysis divided PTMC patients into three clinical categories. In cluster group 1, all patients had no tumor involvement of thyroid capsule, most of them were single tumor, the diameter of tumor was smaller than that of the other two groups, and the rate of lymph node metastasis was the lowest (32.54%). In cluster group 2, the diameter of the tumor was large, the capsule was involved and the lymph node metastasis rate was 38.61%. In cluster group 3, thyroid capsule involvement and multiple tumors was found in all patients (100%), and the lymph node metastasis rate was 57.14%. The results of cluster analysis were further confirmed by univariate correlation analysis and multivariate Logistic regression analysis. Tumor size, number of tumors and thyroid capsule involvement were the impact factors of central lymph node metastasis in PTMC, and thyroid capsule involvement and multiple tumors were the more important factors. Conclusion Central lymph node metastasis is common in PTMC. Tumor size, number of tumors, and thyroid capsule involvement are the impact factors of central lymph node metastasis. Capsule involvement and multiple tumors are more important in the evaluateon of central lymph node metastasis.

Key words: papillary thyroid microcarcinoma, central lymph node metastasis, cluster analysis

中图分类号:

王亚军, 康骅, 赵菁, 海涛, 张小丽, 蔡伟. 甲状腺微小乳头状癌中央区淋巴结转移影响因素的聚类分析研究[J]. 首都医科大学学报, 2021, 42(6): 1053-1059.

Wang Yajun, Kang Hua, Zhao Jing, Hai Tao, Zhang Xiaoli, Cai Wei. Cluster analysis of risk factors of central lymph node metastasis in papillary thyroid microcarcinoma[J]. Journal of Capital Medical University, 2021, 42(6): 1053-1059.

参考文献

[1] Roman B R, Morris L G, Davies L. The thyroid cancer epidemic, 2017 perspective[J]. Curr Opin Endocrinol Diabetes Obes, 2017, 24(5): 332-336.
[2] Weeks K S, Kahl A R, Lynch C F, et al. Racial/ethnic differences in thyroid cancer incidence in the United States, 2007-2014[J]. Cancer, 2018, 124(7): 1483-1491.
[3] Chen W Q, Zheng R S, Baade P D, et al. Cancer statistics in China, 2015[J]. CA Cancer J Clin, 2016, 66(2): 115-132.
[4] Lim H, Devesa S S, Sosa J A, et al. Trends in thyroid cancer incidence and mortality in the United States, 1974-2013[J]. JAMA, 2017, 317(13): 1338-1348.
[5] 庄欢, 杨帆, 廉猛, 等. 甲状腺微小乳头状癌颈部中央区淋巴结转移的相关危险因素分析[J]. 国际耳鼻咽喉头颈外科杂志, 2020, 44(1): 16-19.
[6] Ahlqvist E, Storm P, Käräjämäki A, et al. Novel subgroups of adult-onset diabetes and their association with outcomes: a data-driven cluster analysis of six variables[J]. Lancet Diabetes Endocrinol, 2018, 6(5): 361-369.
[7] Yu I C, Fang J T, Tsai Y F. Exploring demands of hemodialysis patients in Taiwan: a two-step cluster analysis[J]. Plos One, 2020, 15(2): e0228259.
[8] Siddiqui S, White M G, Antic T, et al. Clinical and pathologic predictors of lymph node metastasis and recurrence in papillary thyroid microcarcinoma[J]. Thyroid, 2016, 26(6): 807-815.
[9] Wang X, Tan J, Zheng W, et al. A retrospective study of the clinical features in papillary thyroid microcarcinoma depending on age[J]. Nucl Med Commun, 2018, 39(8): 713-719.
[10] 姜雪,黄学忠,祖国,等.甲状腺微小乳头状癌143例肿瘤大小与超声图像特点关联研究[J].中华肿瘤防治杂志,2019,26(6):395-399.
[11] 高培蓉,张震.超声联合CT诊断家族性甲状腺微小乳头状癌的价值[J].中国医科大学学报,2019,48(5):472-475.
[12] 余小情, 丛阳, 唐蕾, 等. 术前超声漏诊甲状腺癌颈部淋巴结转移的原因分析[J]. 中国超声医学杂志, 2017, 33(2): 101-103.
[13] Jeon M J, Kim W G, Choi Y M, et al. Features predictive of distant metastasis in papillary thyroid microcarcinomas[J]. Thyroid, 2016, 26(1): 161-168.
[14] 王亚军, 康骅, 赵菁, 等. 术中选择性淋巴结冷冻病理检查对甲状腺乳头状癌中央区淋巴结状态的预测作用[J]. 中国现代普通外科进展, 2020, 23(3): 178-181.
[15] 李维.术中冰冻对甲状腺微小乳头状癌的病理诊断价值分析[J].中华肿瘤防治杂志,2018,25(S1):39-40.
[16] Oh H S, Park S, Kim M, et al. Young age and male sex are predictors of large-volume central neck lymph node metastasis in clinical No papillary thyroid microcarcinomas[J]. Thyroid, 2017, 27(10): 1285-1290.
[17] 王朝晖, 张悦嘉, 伏桂明, 等. 甲状腺微小乳头状癌中央区淋巴转移的危险因素分析[J]. 中华耳鼻咽喉头颈外科杂志, 2019, 54(1): 12-17.
[18] Zheng W H, Wang K J, Wu J Z, et al. Multifocality is associated with central neck lymph node metastases in papillary thyroid microcarcinoma[J]. Cancer Manag Res, 2018, 10: 1527-1533.
[19] Kim S K, Park I, Woo J W, et al. Predictive factors for lymph node metastasis in papillary thyroid microcarcinoma[J]. Ann Surg Oncol, 2016, 23(9): 2866-2873.
[20] Cheng F, Chen Y Y, Zhu L, et al. Risk factors for cervical lymph node metastasis of papillary thyroid microcarcinoma: a single-center retrospective study[J]. Int J Endocrinol, 2019, 2019: 8579828.
[21] Zheng X Q, Peng C, Gao M, et al. Risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: a study of 1,587 patients[J]. Cancer Biol Med, 2019, 16(1): 121-130.
[22] Luo Y, Zhao Y, Chen K, et al. Clinical analysis of cervical lymph node metastasis risk factors in patients with papillary thyroid microcarcinoma[J]. J Endocrinol Invest, 2019, 42(2): 227-236.
[23] Siddiqui S, White M G, Antic T, et al. Clinical and pathologic predictors of lymph node metastasis and recurrence in papillary thyroid microcarcinoma[J]. Thyroid, 2016, 26(6): 807-815.
[24] González-Manso A, Agut-Busquet E, Romaní J, et al. Hidradenitis suppurativa: proposal of classification in two endotypes with two-step cluster analysis[J]. Dermatology, 2021, 237(3): 365-371.