Abstract: Objective To retrospectively analyze the clinicopathological characteristics and risk factors for lateral cervical lymph node metastasis of medullary thyroid carcinoma （MTC）. Methods A retrospective analysis was conducted on 45 patients with medullary thyroid carcinoma who underwent initial surgery from November 2013 to November 2021 at Sun Yat-sen University′s Sun Yat-sen Memorial Hospital, using a single factor analysis and a multivariate logistic regression model. Results Among the clinicopathological features, the ratio of male to female was 1.25∶1, with 29 （64.4%） lymph node metastases in the central region and 15 （33.3%） lymph nodes in the lateral cervical region. Univariate analysis showed that patients with primary tumor diameter≥1.9 cm, tumor invasion of capsule, and≥4 lymph nodes in the central cervical region considered for metastasis had a significantly higher risk of lateral cervical lymph node metastasis （P<0.05）. In multivariate logistic analysis, the results showed that only the maximum diameter of the tumor affected the probability of lateral cervical lymph node metastasis, with statistical significance （P<0.05）. Conclusion Compared with thyroid papillary carcinoma, the male patients with MTC in this article had a higher incidence rate than the female patients. When the tumor diameter of MTC patients is ≥1.9 cm, the tumor invades the capsule, and the lymph nodes in the central region of the neck are considered to have multiple metastases, the lymph nodes in the lateral region of the neck should be fully evaluated before surgery to avoid omission and secondary surgery.

Key words: thyroid carcinoma, medullary carcinoma, lateral cervical lymph nodes, lymph node metastasis, risk factors

摘要： 目的 回顾分析甲状腺髓样癌（MTC）的临床病理特征及侧颈淋巴结转移风险因素。方法 回顾性分析中山大学孙逸仙纪念医院2013年11月至2021年11月期间初次手术且术后病理报告为甲状腺髓样癌的患者45例,通过Logistic回归模型分析侧颈区淋巴结转移的风险因素。结果 临床病理特征中,男女比例为1.25∶1,中央区淋巴结转移29人（64.4%）,颈外侧区淋巴结15人（33.3%）。单因素分析显示原发灶肿瘤直径≥1.9 cm、肿瘤侵犯被膜/腺体外、中央区淋巴结转移个数≥4个的患者侧颈区淋巴结转移风险明显增高（P<0.05）。多因素Logistic分析结果显示仅肿瘤直径是影响侧颈区淋巴结转移的独立风险因素,具有统计学意义（P<0.05）。结论 相比较于甲状腺乳头状癌的患者,本文中MTC的患者男性发病率高于女性,对于肿瘤直径≥1.9 cm、肿瘤侵犯被膜、颈中央区淋巴结考虑多发转移的甲状腺髓样癌患者,术前更应充分评估患者侧颈区淋巴结以免遗漏。

关键词: 甲状腺肿瘤, 髓样癌, 侧颈区淋巴结, 淋巴结转移, 风险因素