The Distribution Of TCM Syndromes And The Regularity Of Cervical Lymph Node Metastasis In HT Combined With PTC

Objective:To investigate the distribution characteristics of Traditional Chinese Medicine(TCM)syndrome types and the regularity of cervical lymph node metastasis in PTC with HT,providing references for clinical diagnosis and treatment.Methods:From June 2020 to January 2021,patients with PTC combined with HT who underwent surgy at Thyroid and Breast Surgery Department,Affiliated Hospital of Integrated traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,were included.Before surgery,the patients were confirmed their TCM syndrome,Baseline data(age,gender,height,weight,TSH level,TPOAb,TgAb,thyroid ultrasound,BRAF V600E gene)and postoperative pathological results(bilateral or unilateral,number,maximal diameter,capsular invasion and lymph node metastasis).Single factor analysis screened out the relevant variables,then use binary logistic regression to get the relevant independent factors,and analyze the distribution characteristics of medical syndrome types and the law of cervical lymph node metastasis.Results:A total of 106 patients PTC combined with HT were enrolled in the study.Their TCM syndrome included phlegm-dampness coagulation syndrome(41 cases,38.68%),phlegm and blood stasis syndrome(33 cases,31.13%),liver-qi stagnation syndrome(24 cases,22.64%)and Yin deficiency internal heat syndrome(8 cases,7.55%).Elevated TPOAb were rare in phlegm and blood stasis syndrome(2/19,P=0.032),while were more common in liver-qi stagnation syndrome(9/19,P=0.012).Overweight and obese were more common phlegm-dampness coagulation syndrome(21/41,P=0.035),while were rare in Yin-deficiency internal heat syndrome(0/8,P=0.022).Multifocality(≥2 foci)(18/39,P=0.011)were more common in syndrome of phlegm and blood stasis.Microcarcinoma(d<1cm)(21/67,P=0.042)were more common in syndrome of phlegm-dampness coagulation.Unilateral thyroid and isthmus lobectomy were practiced in 61 patients.Total thyroidectomy were practiced in 45 patients.All the patients were practiced with central lymph node dissection.There was 51 patients(48.1%)confirmed with central lymph node metastasis(CLNM)by postoperative pathology.23 patients were suspicious of lateral lymph node metastasis(LLNM),and only 17 cases(16.0%)were confirmed with LLNM by pathology.We found that age(P=0.032),number(P=0.035),maximal diameter(P<0.001)were significantly related with CLNM.Age<55 years(OR=14.583,P=0.019),multifocality(OR=3.203,P=0.017)and maximal diameter≥0.65cm(OR=5.451,P=0.001)were the independent risk factors for CLNM.Patients with capsule invasion(5/9,P=0.047)and bilateral cancer foci(8/19,P=0.035)were more likely to develop LLNM,but bilateral cancer(OR=2.737,P=0.078)and capsule invasion(OR=2.874,P=0.113)were the independent factors of LLNM.The increase of TgAb or TPOAb alone and TgAb with TPOAb at the same time had no significant correlation with CLNM and LLNM(P>0.05).Conclusion:1.The most common TCM syndrome in patients with PTC combined with HT is phlegm dampness coagulation syndrome related to weight and tumor diameter,followed by phlegm and blood stasis syndrome related to Elevated TPOAb and multifocality.The third is liver-qi stagnation syndrome,which is related to the increase of TPOAb alone.The least common type of syndrome is Yin deficiency and internal heat syndrome,related to body weight.2.Age≥55 years,diameter<0.65cm,and unifocal are protective factors for CLNM in PTC with HT.Unilateral/bilateral and envelope invasion are related to LLNM,but not independent factors of LLNM.No matter CLNM or LLNM,had no significant connection with the increase of TgAb or TPOAb alone and TgAb with TPOAb at the same time.3.For patients with HT combined with PTC who are suspected of having LLNM before surgery,puncture eluent detect thyroglobulin and pathological examination should be given as much as possible to reduce unnecessary neck area dissection.