Clinical analysis of medullary thyroid carcinoma and risk factors of cervical lymph node metastasis
10.3760/cma.j.issn.1674-6090.2019.02.011
- VernacularTitle:甲状腺髓样癌临床特征及颈部淋巴结转移风险因素讨论
- Author:
Qiaochu LU
1
;
Lijun FU
;
Liwen LI
;
Xinguang QIU
Author Information
1. 郑州大学第一附属医院甲状腺外科 450001
- Keywords:
Medullary thyroid carcinoma;
Lymph node metastasis;
Calcitonin;
Carcinoembryonic antigen
- From:
Chinese Journal of Endocrine Surgery
2019;13(2):139-143
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the clinical features of medullary thyroid carcinoma(MTC) and the risk factors of cervical lymph node metastasis.Methods A retrospective analysis of 84 cases of thyroid surgery in the First Affiliated Hospital of Zhengzhou University from Jan.2012 to Jun.2018 and confirmed by routine pathology as MTC patients was performed.Chi-square test and logistic regression were used to analyze patients' age,gender,clinical features such as tumor diameter,number of lesions,and invasion of the capsule and risk factors associated with cervical lymph node metastasis.Results Statistical analysis found that the incidence of lymph node metastasis significantly increased in patients with central region ≥ 1 cm (x2=4.196,P=0.041),multiple lesions (x2=5.946,P=0.015),and thyroid capsule invasion (x2=15.277,P＜0.001) and the difference was statistically significant.The incidence of cervical lymph node metastasis was significantly higher in patients with the tumor diameter ≥ 1 cm(x2=5.269,P=0.022),multiple lesions(x2=4.550,P=0.033),and thyroid capsule invasion(x2=19.253,P＜0.001) and the difference was statistically significant.Logistic regression analysis showed that thyroid capsule invasion was an independent risk factor for central lymph node metastasis (OR=7.551,P=0.001) and cervical lymph node metastasis (OR=8.067,P＜0.001).Of the 84 patients who received calcitonin before surgery,56 patients had preoperative calcitonin＞200 pg/ml,and the cervical lymph node metastasis rate was 55.4％ (31/56).28 patients had preoperative calcitonin＜200 pg/ml,and the cervical lymph node metastasis rate was 28.6％ (8/28).The former increased and the difference was statistically significant.Of the 18 patients who underwent preoperative detection of carcinoembryonic antigen (CEA),8 patients had CEA＞30 ng/ml,cervical lymph node metastasis was 75％ (6/8);10 patients had CEA＜30 ng/ml,and the cervical lymph node metastasis was 60％(6/10).Conclusions Higher cervical lymph node metastasis is a clinical feature of MTC.For patients with thyroid capsule invasion,the risk of cervical lymph node metastasis is significantly increased,and prophylactic cervical lymph node dissection is required.Preoperative detection of calcitonin and CEA can be used to diagnose MTC and predict lymph node metastasis.The cervical lymph node dissection can be considered with reference to the concentration.
