甲状腺乳头状癌患者超重与淋巴结转移关系及性别异质性分析

Association between overweight and lymph node metastasis in patients with papillary thyroid carcinoma and its sex-based heterogeneity

摘要:

背景与目的 甲状腺乳头状癌（PTC）是中国发病率最高的内分泌恶性肿瘤，颈部淋巴结转移是其常见且重要的临床特征，直接关系到患者的预后和复发风险。近年来，随着中国超重和肥胖人群的快速增加，体质量指数（BMI）在多种肿瘤中的作用受到关注。本研究旨在探讨超重与PTC颈部淋巴结转移之间的关系，并分析其性别差异及影响因素，为临床精准诊疗提供依据。方法 回顾性分析中南大学湘雅医院2021年8月—2022年6月间收治的1 445例经典型PTC患者的临床病理资料。根据是否存在淋巴结转移分组，应用限制性立方样条分析BMI与淋巴结转移的非线性关系，并采用单因素及多因素Logistic回归分析各因素的独立影响。进一步对BMI≥24 kg/m2的超重患者进行性别分层分析，筛选男性与女性患者中淋巴结转移的独立危险因素。结果 在全部患者中，716例（49.6%）出现淋巴结转移。单因素分析结果显示，BMI、性别、年龄、肿瘤直径、多灶性、腺外侵犯等与PTC患者颈部淋巴结转移明显有关（均P<0.05）。BMI与转移风险呈非线性正相关，尤其在男性中更明显。此外，PTC患者的BMI与甘油三酯呈正相关，与高密度脂蛋白胆固醇呈负相关。性别分层分析发现，在男性超重PTC患者中，年龄（OR=0.954）、肿瘤直径（OR=1.085）、多灶性（OR=2.776）是淋巴结转移的独立危险因素；在女性超重PTC患者中，年龄（OR=0.943）和肿瘤直径（OR=1.074）为主要影响因素。结论 超重与PTC颈部淋巴结转移密切相关，且不同性别的超重患者转移的高危因素存在差异。年轻、病灶大、多灶性的男性超重患者，以及年轻、病灶大的女性超重患者转移风险较高。建议对上述高危人群在术前加强评估，优化淋巴结清扫策略，以实现精准治疗和风险控制。

Abstract:

Background and Aims Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy in China, with cervical lymph node metastasis being a frequent and critical clinical feature that directly affects patient prognosis and recurrence risk. In recent years, with the rapid increase in the prevalence of overweight and obesity in China, the role of body mass index (BMI) in various tumors has attracted growing attention. This study aimed to investigate the association between overweight and cervical LNM in PTC, analyze sex-specific differences and influencing factors, and provide evidence for precise clinical management.Methods A retrospective analysis was conducted on the clinicopathologic data of 1 445 patients with classical PTC treated at Xiangya Hospital of Central South University between August 2021 and June 2022. Patients were divided into groups based on the presence or absence of lymph node metastasis. Restricted cubic spline analysis explored the nonlinear relationship between BMI and lymph node metastasis risk. Univariate and multivariate Logistic regression analyses were applied to identify independent risk factors. Furthermore, sex-stratified analysis was performed among overweight patients (BMI ≥24 kg/m2) to determine sex-specific risk factors for lymph node metastasis.Results Among all patients, 716 (49.6%) had lymph node metastasis. Univariate analysis showed that BMI, sex, age, tumor diameter, multifocality, and extrathyroidal extension were significantly associated with cervical lymph node metastasis in PTC patients (all P<0.05). A nonlinear positive correlation was observed between BMI and lymph node metastasis risk, which was more pronounced in male patients. Additionally, BMI was positively correlated with triglyceride levels and negatively correlated with high-density lipoprotein cholesterol. Sex-stratified analysis revealed that in overweight male patients, younger age (OR=0.954), larger tumor diameter (OR=1.085), and multifocality (OR=2.776) were independent risk factors for LNM; in overweight female patients, younger age (OR=0.943) and larger tumor diameter (OR=1.074) were the main influencing factors.Conclusion Overweight is closely associated with cervical lymph node metastasis in PTC, and the high-risk factors for LNM differ between male and female overweight patients. Young age, larger tumor size, and multifocality in overweight males, and young age and larger tumors in overweight females indicate a higher risk of metastasis. It is recommended that high-risk populations receive enhanced preoperative evaluation and individualized lymph node dissection strategies to achieve precise treatment and improved risk control.