Clinical Characteristics Of Lymph Node Metatasis In Aged Differentiated Thyroid Carcinoma Treated With Radioiodine

ObjectiveThyroid carcinoma is the most common endocrine system tumor in clinic.The main clinical manifestation is painless thyroid nodules.The incidence rate of thyroid carcinoma is increasing year by year.In addition to the cancer itself,the increase in the incidence rate has a certain correlation with the improvement of examination methods and sensitivity,the increase of economic level,and the improvement of anti-cancer awareness.This may also be the reason why the prevalence of thyroid cancer in the elderly has increased.Older patients have poorer prognosis compared with younger and middle-aged patients,and there are higher rates of recurrence and metastasis.Research on the risk factors associated with lymph node metastasis in elderly patients is rarely reported.To explore the clinical features and risk factors of lymph node metastasis in elderly patients with differentiated thyroid cancer,and to provide a certain clinical basis for the development of personalized treatment plans for this special population.MethodsThis study retrospectively analyzed the clinical data of 83 patients with differentiated thyroid carcinoma after total thyroidectomy who underwent radionuclide 131-I treatment in the Department of Endocrinology,Qianfoshan Hospital,Shandong Province from January 2014 to July 2016.Analyze and record their gender,age,tumor diameter(maximum diameter),tumor invasion single leaf or double leaf,invasion and envelope,single or multiple tumors,serum Tg-Ab levels,serum TPO-Ab levels,serum TSH Levels,whether or not Hashimoto's thyroiditis and nodular goiter were grouped according to whether lymph node metastasis occurred or not,and the clinical features and independent risk factors of lymph node metastasis were analyzed by univariate and multivariate factors.Results1.This study included a total of 83 subjects aged 60 years and over,of whom 65 were younger than 70(78.31%),18 were older than 70(21.69%),20 were men(24.10%),and 63 were women(75.90%).There were 46 individuals(55.42%)and 37 cases(44.58%);51(61.45%)invaded unilateral lobes and 32(38.55%)in both sides;49(59.04%)invaded the capsules.41(49.40%)calcified;51(61.45%)with nodular goiter,18(21.69%)with Hashimoto's thyroiditis,53(63.89%)with metastasis,and central lymph node metastasis.44 In humans(53.01%),there were 30 patients(36.14%)with lymph node metastasis.The iodine number of all subjects was 1.75±0.78.After treatment,32(38.55%)were cured and 46(55.42%)were cured.Five people(6.02%)had a total of 78(93.98%).2.Univariate analysis showed that: gender,age,single or multiple tumors,invasion of unilateral or bilateral glands,invasion of the capsule,calcification,nodular goiter,accompanied by Hashimoto's thyroiditis,TG-Ab levels and lymph node metastasis were statistically significant(P <0.05);females,age <70 years,multiple tumors,tumor invasion and bilateral glands,invasion,touch,lesions associated with calcification,accompanied by Patients with nodular goiter and higher TG-Ab levels had higher lymph node metastases.Multivariate analysis showed that age,TG-Ab,tumor number,invading glandular lobe,invading capsule,and calcification were independent risk factors for lymph node metastasis in elderly DTC patients.In elderly DTC patients with Hashimoto's thyroiditis,univariate and multivariate analysis showed that it was not a risk factor for lymph node metastasis in elderly DTC patients,but a protective factor for cervical lymph node metastasis.3.There was no significant difference in the cure rate between elderly patients with cervical lymph node metastasis and those without lymph node metastasis,but there were more frequent radioiodine treatments.Conclusion1.Age < 70,multiple foci,invasion of gland lobes,invasion of capsule,calcification are independent risk factors of lymph node metastasis in elderly differentiated thyroid carcinoma.2.Serum TG-Ab was one of the independent risk factors for lymph node metastasis in elderly differentiated thyroid carcinoma.There was no significant difference between serum TG-Ab,TSH and lymph node metastasis of differentiated thyroid carcinoma.However,the mean level of serum TSH in patients with cervical lymph node metastasis was significantly higher than that without lymph node metastasis.3.In elderly patients with differentiated thyroid carcinoma,the risk factors of lymph node metastasis should be fully evaluated and individualized treatment should be carried out,and standardized radioactive iodine therapy should be taken after operation to reduce the recurrence of the lesions.Prolong the patient's life span and improve the patient's quality of life.