甲状腺髓样癌侧颈淋巴结转移危险因素的单中心回顾性分析

Risk factors for lateral cervical lymph node metastasis in medullary thyroid carcinoma: a single-center retrospective analysis

摘要:

背景与目的 甲状腺髓样癌（MTC）恶性程度较高，常伴颈部淋巴结转移，对预后影响显著。然而，目前对MTC侧颈淋巴结转移（LLNM）的风险因素尚缺乏统一认识。本研究旨在分析MTC患者发生LLNM的危险因素，以期为制定个体化手术方案提供依据。方法 回顾性分析2011—2019年在天津医科大学肿瘤医院接受手术治疗的242例MTC患者临床病理资料，评估术前降钙素水平、CEA水平等肿瘤标志物与LLNM的关系，并采用单因素与多因素Logistic回归分析探讨LLNM的独立危险因素。结果 术前降钙素水平与肿瘤直径、淋巴结转移数量及淋巴结转移数范围明显有关，而术前CEA水平与肿瘤直径明显有关（均P<0.05）；术前降钙素水平诊断LLNM的ROC曲线下面积为0.750（P=0.000），最佳截断值266.00 ng/L（敏感度0.854，特异度0.577），术前CEA水平对LLNM的诊断价值有限。单因素分析显示，性别、侵出腺叶、T分期、中央区淋巴结转移（CLNM）、双侧、术前降钙素水平、肿瘤直径和多灶性与MTC患者LLNM明显有关（均P<0.05）；多因素分析显示，CLNM（OR=17.645，95% CI=7.728~40.290）和术前降钙素≥266.00 ng/L（OR=7.832，95% CI=3.132~19.582）是MTC患者发生LLNM的独立危险因素。结论 CLNM及术前降钙素水平升高与MTC患者发生LLNM密切相关。联合这两项指标可有效筛选LLNM高风险人群，推动MTC治疗的个体化与精准化。

Abstract:

Background and Aims Medullary thyroid carcinoma (MTC) is an aggressive malignancy that is frequently associated with cervical lymph node metastasis, significantly affecting patient prognosis. However, the risk factors for lateral cervical lymph node metastasis (LLNM) in MTC remain inconclusive. This study aims to identify the risk factors associated with LLNM in MTC patients, in order to inform individualized surgical decision-making.Methods The clinicopathologic data of 242 patients with MTC who underwent surgical treatment at Tianjin Medical University Cancer Institute and Hospital from 2011 to 2019 were retrospectively collected. The relationships between preoperative tumor markers, including calcitonin and carcinoembryonic antigen (CEA), and LLNM were evaluated. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for LLNM.Results Preoperative calcitonin level was significantly associated with tumor diameter, the number of lymph node metastases, and the extent of lymph node involvement, while preoperative CEA level was significantly associated with tumor diameter (all P<0.05). The area under the ROC curve for preoperative calcitonin in diagnosing LLNM was 0.750 (P=0.000), with an optimal cutoff value of 266.00 ng/L (sensitivity 0.854, specificity 0.577). The diagnostic value of preoperative CEA for LLNM was limited. Univariate analysis showed that sex, extracapsular extension, T stage, central lymph node metastasis (CLNM), bilateral lesions, preoperative calcitonin, tumor diameter, and multifocality were significantly associated with LLNM in MTC patients (all P<0.05). Multivariate analysis revealed that CLNM (OR=17.645, 95% CI=7.728-40.290) and preoperative calcitonin ≥266.00 ng/L (OR=7.832, 95% CI=3.132-19.582) were independent risk factors for LLNM.Conclusion CLNM and elevated preoperative calcitonin level are closely associated with LLNM in patients with MTC. The combination of these two indicators may help identify high-risk patients for LLNM, thereby and promoting individualized and precise treatment strategies for MTC.