Bhattacharyya Neil
Division of Otolaryngology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Arch Otolaryngol Head Neck Surg. 2003 Oct;129(10):1101-4. doi: 10.1001/archotol.129.10.1101.
To determine if more extensive neck dissection in patients with papillary carcinoma of the thyroid affords a survival benefit vs limited lymphadenectomy of positive nodal disease.
Survey analysis of a national cancer database.
Cases of papillary thyroid carcinoma were extracted from the Surveillance, Epidemiology, and End Results database for January 1, 1988, to December 31, 1999, along with demographic, staging, and treatment variables. Cases were limited to patients who underwent total thyroidectomy and postoperative radioactive iodine treatment along with excision of 1 or more positive cervical nodes. Patients were divided into 2 groups: those undergoing limited lymphadenectomy of only positive nodes and those undergoing more extensive neck dissection with removal of positive and negative nodes.
Among 2097 patients with papillary carcinoma meeting treatment criteria, 880 underwent limited lymphadenectomy and 1217 underwent neck dissection. The mean age, sex distribution, primary tumor extent and size, and follow-up duration were not different between these 2 groups (P>.05 for all). The mean survival for patients undergoing limited lymphadenectomy was 135 months, vs 136 months for patients undergoing neck dissection. Actuarial 5-year (10-year) survival rates were 94.4% (91.3%) and 95.9% (92.4%), respectively. Kaplan-Meier survival was not different between groups (P =.40, log-rank test).
Limited lymphadenectomy of positive nodal disease in patients with papillary carcinoma affords survival similar to that of patients undergoing more extensive neck dissections. Therefore, a formal neck dissection may not be required for the effective treatment of cervical nodal metastases in patients with papillary carcinoma of the thyroid.
确定甲状腺乳头状癌患者行更广泛的颈部清扫术与对阳性淋巴结疾病进行有限的淋巴结切除术相比，是否能带来生存获益。
对国家癌症数据库进行调查分析。
从监测、流行病学和最终结果数据库中提取1988年1月1日至1999年12月31日期间的甲状腺乳头状癌病例，以及人口统计学、分期和治疗变量。病例仅限于接受全甲状腺切除术、术后放射性碘治疗以及切除1个或更多阳性颈部淋巴结的患者。患者分为两组：仅对阳性淋巴结进行有限淋巴结切除术的患者和对阳性及阴性淋巴结进行更广泛颈部清扫术的患者。
在2097例符合治疗标准的乳头状癌患者中，880例行有限淋巴结切除术，1217例行颈部清扫术。这两组患者的平均年龄、性别分布、原发肿瘤范围和大小以及随访时间均无差异（所有P>0.05）。行有限淋巴结切除术患者的平均生存期为135个月，而行颈部清扫术患者为136个月。5年（10年）精算生存率分别为94.4%（91.3%）和95.9%（92.4%）。两组之间的Kaplan-Meier生存率无差异（P = 0.40，对数秩检验）。
甲状腺乳头状癌患者对阳性淋巴结疾病进行有限淋巴结切除术的生存率与行更广泛颈部清扫术的患者相似。因此，对于甲状腺乳头状癌患者颈部淋巴结转移的有效治疗，可能不需要进行正规的颈部清扫术。
