背景:近几十年来,甲状腺微小癌(TMC)的发病率显著增加。TMC≤5mm的患者与>5mm的患者相比,甲状腺外淋巴结转移的发生率存在显着差异。当前的分析旨在检查测量<5mm的TMC的临床病理特征,并将其与≥5mm的TMC进行比较。
方法:从2020年12月至2021年5月,BachMai医院共纳入273例经组织学检查证实的TMC患者,河内,越南。非条件logistic回归模型用于确定临床病理因素与肿瘤大小之间的关系。中央区淋巴结转移和甲状腺外扩展。
结果:我们发现212/273例患者(77.7%)是偶然诊断的。大多数患者为女性(87.5%),平均年龄为44.2岁。平均肿瘤大小(±标准偏差(SD))为5.72±2.33mm。大多数患者也被诊断为乳头状TMC。多灶性和双侧病变占13.2%和12.1%,分别。14.7%(40例)观察到甲状腺外侵袭,而24.5%(67例)是中央区淋巴结转移者。肿瘤大小≥5mm的患者的甲状腺外扩展率明显高于肿瘤大小<5mm的患者(比值比(OR)=4.98;95%置信区间(CI):1.48-16.70;p=0.004)。与BMI≥23kg/m2的患者相比,体重指数(BMI)<23kg/m2的患者被发现可以防止甲状腺外扩张的几率(OR=0.38,95%CI:0.19-0.75;p=0.004)。在单变量模式下,中央区淋巴结转移与甲状腺外扩展的可能性呈正相关(OR=2.70,95%CI:1.34-5.45;p=0.004).在多变量模型中,中央区淋巴结转移也与甲状腺外扩张相关(OR=2.507,95%CI:1.194-5.264;p=0.017).单因素分析显示肿瘤大小≥5mm(OR=2.04;95%CI:1.01~4.17;p=0.047)和甲状腺外扩张(OR=2.71;95%CI:1.34~5.45;p=0.004)是颈中央淋巴结转移的危险因素。在多变量模型中,甲状腺外延伸与中央区淋巴结转移有关.
结论:TMC<5mm的肿瘤不太可能具有侵袭性特征,包括甲状腺外延伸,比TMC≥5mm。因此,有必要进行长期随访研究以研究TMC预后的因素。
BACKGROUND: Thyroid microcarcinoma (
TMC) incidence has significantly increased in recent decades. The rates of lymph node metastasis extrathyroidal extension have been significantly different in patients with
TMC ≤5 mm versus those with size >5 mm. The current analysis aimed to examine the clinicopathologic features of TMC measuring <5 mm and to compare them with those of
TMC ≥5 mm.
METHODS: A total of 273 patients with TMC confirmed by histological examination from December 2020 to May 2021 were enrolled in Bach Mai Hospital, Hanoi, Vietnam. Unconditional logistic regression models were used to determine the association between clinicopathological factors and tumor size, central lymph node metastasis and extrathyroidal extension.
RESULTS: We found 212/273 patients (77.7%) were diagnosed incidentally. The majority of patients were female (87.5%) and had a mean age of 44.2 years. The mean tumor size (±standard deviation (SD)) was 5.72 ± 2.33 mm. Most of the patients were also diagnosed with papillary
TMC. Multifocal and bilateral lesions accounted for 13.2% and 12.1%, respectively. The extrathyroidal invasion was observed in 14.7% (40 patients), while 24.5% (67 patients) were those with central lymph node metastases. The rate of extrathyroidal extension in patients with tumor size ≥5 mm was significantly higher than in patients with tumor size <5 mm (odds ratio (OR) = 4.98; 95% confidence interval (CI): 1.48-16.70; p = 0.004). Patients with body mass index (BMI) <23 kg/m2 were found to be protected against the odds of extrathyroidal extension (OR = 0.38, 95% CI: 0.19-0.75; p = 0.004) compared to those with BMI ≥23 kg/m2. In univariable mode, central lymph node metastasis was positively associated with the odds of the presence of extrathyroidal extension (OR = 2.70, 95% CI: 1.34-5.45; p = 0.004). In the multivariable model, central lymph node metastasis was also associated with the presence of extrathyroidal extension (OR = 2.507, 95% CI: 1.194-5.264; p = 0.017). Univariate analysis demonstrated that tumor size ≥5 mm (OR = 2.04; 95% CI: 1.01-4.17; p = 0.047) and extrathyroidal extension (OR = 2.71; 95% CI: 1.34-5.45; p = 0.004) were risk factors of central cervical lymph node metastasis. In multivariable models, the extrathyroidal extension was associated with central lymph metastasis.
CONCLUSIONS: TMC <5 mm tumor size is less likely to have aggressive characteristics, including extrathyroidal extension, than a
TMC ≥5 mm. Long-term follow-up studies are thus warranted to investigate the factors in the prognosis of TMC.