Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
Ann Surg Oncol. 2012 Jan;19(1):60-7. doi: 10.1245/s10434-011-1833-x. Epub 2011 Jun 17.
Prophylactic central neck dissection (CND) remains controversial in papillary thyroid carcinoma (PTC). Because postsurgical stimulated thyroglobulin (sTg) level is a good surrogate for recurrence, the study aimed to evaluate the impact of prophylactic CND on preablative and postablative sTg levels after total thyroidectomy.
Of the 185 patients retrospectively analyzed, 82 (44.3%) underwent a total thyroidectomy and prophylactic CND (CND-positive group) while 103 (55.7%) underwent total thyroidectomy only (CND-negative group). All patients had no preoperative or intraoperative evidence of lymph node metastases. Clinicopathological characteristics, postoperative outcomes, and preablative and postablative sTg levels were compared between the two groups. Preablative sTg level was taken at the time of radioiodine ablation, while postablative sTg level was taken 6 months after ablation. A multivariable analysis was conducted to identify factors for preablative athyroglobulinemia (sTg<0.5 μg/L).
Relative to the CND-negative group, the CND-positive group had larger tumors (15 mm vs. 10 mm, P < 0.005), more extrathyroidal extension (26.8% vs. 14.6%, P<0.003), more tumor, node, metastasis system stage III disease (32.9% vs. 9.7%, P < 0.001), and more temporary hypoparathyroidism (18.3% vs. 8.7%, P=0.017). Fourteen patients (17.1%) in the CND-positive group were upstaged from stages I/II to III as a result of prophylactic CND. The CND-positive group experienced lower median preablative sTg (<0.5 μg/L vs. 6.7 μg/L, P < 0.001) and a higher rate of preablative athyroglobulinemia (51.2% vs. 22.3%, P = 0.024), but these differences were not observed 6 months after ablation. Prophylactic CND was the only independent factor for preablative athyroglobulinemia.
Although performing prophylactic CND in total thyroidectomy may offer a more complete initial tumor resection than total thyroidectomy alone by minimizing any residual microscopic disease, such a difference becomes less noticeable 6 months after ablation.
预防性中央颈部清扫术（CND）在甲状腺乳头状癌（PTC）中仍存在争议。由于术后刺激甲状腺球蛋白（sTg）水平是复发的良好替代指标，因此本研究旨在评估全甲状腺切除术后预防性 CND 对术前和术后 sTg 水平的影响。
回顾性分析了 185 例患者，其中 82 例（44.3%）行全甲状腺切除术和预防性 CND（CND 阳性组），103 例（55.7%）行全甲状腺切除术（CND 阴性组）。所有患者均无术前或术中淋巴结转移的证据。比较两组患者的临床病理特征、术后结局以及术前和术后 sTg 水平。术前 sTg 水平在放射性碘消融时采集，术后 sTg 水平在消融后 6 个月采集。进行多变量分析以确定术前无甲状腺球蛋白血症（sTg<0.5μg/L）的因素。
与 CND 阴性组相比，CND 阳性组肿瘤更大（15mm 比 10mm，P<0.005），甲状腺外侵犯更多（26.8%比 14.6%，P<0.003），肿瘤、淋巴结、转移系统分期 III 期疾病更多（32.9%比 9.7%，P<0.001），暂时性甲状旁腺功能减退症更多（18.3%比 8.7%，P=0.017）。14 例（17.1%）CND 阳性组患者因预防性 CND 而从 I/II 期升级为 III 期。CND 阳性组术前 sTg 中位数较低（<0.5μg/L 比 6.7μg/L，P<0.001），术前无甲状腺球蛋白血症发生率较高（51.2%比 22.3%，P=0.024），但消融后 6 个月无差异。预防性 CND 是术前无甲状腺球蛋白血症的唯一独立因素。
尽管全甲状腺切除术中行预防性 CND 可能比单纯全甲状腺切除术更彻底地切除初始肿瘤，从而最大限度地减少任何残留的显微镜下疾病，但这种差异在消融后 6 个月时变得不那么明显。
