中国普通外科杂志2025，Vol.34Issue(5)：892-902,11.DOI:10.7659/j.issn.1005-6947.240676
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
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.关键词
甲状腺癌,乳头状/淋巴转移/超重/危险因素Key words
Thyroid Cancer,Papillary/Lymphatic Metastasis/Overweight/Risk Factors分类
医药卫生引用本文复制引用
陈璐,孙妍,詹志君,谭海龙,李宁,尹俊达,唐能,常实,黄鹏..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[J].中国普通外科杂志,2025,34(5):892-902,11.基金项目
国家自然科学基金资助项目(82472881) （82472881）
湖南省科技创新计划基金资助项目(2024JK2140) （2024JK2140）
湖南省研究生科研创新基金资助项目(QL20230044) （QL20230044）
中南大学中央高校基本科研业务费专项基金资助项目(2024ZZTS0871). （2024ZZTS0871）
