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目的分析多灶性乳头状甲状腺癌(PTC)中Ki-67、Cyclin D1和Bcl-2的表达与转移复发的关系。方法收集92例多灶性PTC,淋巴结转移和复发59例,检测Ki-67、Cyclin D1和Bcl-2在多灶性PTC及不同分区淋巴结、原发与复发的癌组织中的表达差异,结合临床病理因素,分析其与多灶PTC转移复发的关系。结果 92例多灶性PTC中54例淋巴结转移,复发33例,Ⅵ区与Ⅱ～Ⅴ区淋巴结转移、淋巴结转移与复发正相关(P<0.01)。Ki-67、Cyclin D1和Bcl-2在多灶性PTC中高表达与转移、复发有关(P<0.05),在Ⅵ区和Ⅱ～Ⅴ区转移淋巴结中表达呈正相关(P<0.05);三者在原发癌与转移灶、复发前后癌灶中的表达差异无统计学意义(P>0.05);Bcl-2和Ki-67、Cyclin D1三者表达正相关(P<0.05)。结论多灶性PTC转移复发病例中Ki-67、Cyclin D1和Bcl-2高表达,Ⅵ区与Ⅱ～Ⅴ区淋巴结转移正相关,手术方式宜选择甲状腺全切术加中央区淋巴结清扫术,术中快速病理检查,以决定是否行选择性颈外侧区淋巴结清扫,以降低肿瘤复发的危险。
Objective To analyze the relationship between the expression of Ki-67, Cyclin D1 and Bcl-2 and metastasis and recurrence in multifocal papillary thyroid carcinoma (PTC). Methods Ninety-nine cases of multifocal PTC, lymph node metastasis and recurrence were collected in 59 cases. The expression differences of Ki-67, Cyclin D1 and Bcl-2 in multifocal PTC and different regional lymph nodes, primary and recurrent cancer tissues were detected. Clinical and pathological factors, analyze the relationship with multifocal PTC metastasis recurrence. Results Of the 92 cases with multifocal PTC, 54 cases had lymph node metastasis and 33 cases relapsed. There was a positive correlation between lymph node metastasis and lymph node metastasis and recurrence in Ⅵ and Ⅱ ~ Ⅴ regions (P <0.01). The high expression of Ki-67, Cyclin D1 and Bcl-2 in multifocal PTC was correlated with the metastasis and recurrence (P <0.05), and positively correlated with the metastasis of lymph nodes in Ⅵ and Ⅱ ~ Ⅴ (P <0.05) The expression of Bcl-2, Ki-67 and Cyclin D1 was not significantly different between the primary cancer and metastasis and the recurrence before and after the cancer (P> 0.05). Conclusions Ki-67, Cyclin D1 and Bcl-2 are highly expressed in patients with multifocal PTC. There is a positive correlation between the level of Ki-67 and lymph node metastasis in zone ¢ ó ~ ¢ ñ. The total thyroidectomy plus central lymph node dissection Rapid pathological examination to determine whether the line of selective cervical lateral lymph node dissection to reduce the risk of tumor recurrence.