Kandil Emad, Friedlander Paul, Noureldine Salem, Islam Tareq, Tufano Ralph P
Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
ORL J Otorhinolaryngol Relat Spec. 2011;73(6):330-5. doi: 10.1159/000330047. Epub 2011 Oct 11.
Cervical lymph node metastasis commonly occurs in papillary thyroid cancer. Emerging evidence from large population-based studies demonstrates decreased survival with regional lymph node metastasis. There is considerable debate in the literature regarding the optimal initial treatment for papillary thyroid cancer. We hypothesized that overall survival is influenced by the extent of neck involvement and neck dissection.
The Surveillance, Epidemiology and End Results database was used to identify all patients with papillary thyroid cancer who underwent thyroidectomy. Patients with distant metastasis, invalid, or missing staging, and neck dissection information were excluded. A Kaplan-Meier survival estimate and a multivariate adjusted Cox regression model were used to estimate survival rates of patients undergoing selective, modified, and radical neck dissection as compared to those who did not have a neck dissection.
3,439 eligible patients were included in this analysis. The mean age was 45 years; 76% were females and 86% were white. 2,414 (70.1%) of the patients underwent thyroidectomy without any neck dissection, whereas selective (limited), modified and radical neck dissections were performed on 19.3, 7.9 and 2.7% of the patients, respectively. Five-year patient survival rates were 96.6, 96.4, 89.5 and 80.9% among patients who had no neck dissection, selective, modified, and radical neck dissections, respectively. After adjusting for age, gender and race, the hazard ratios and 95% confidence intervals of survival for modified and radical neck dissection were 2.35 (95% CI: 1.46-3.78) and 4.48 (95% CI: 2.57-7.84), respectively, as compared to no neck dissection (p < 0.001). Similar associations were also noted after stratifying by localized or regional tumor.
Extensive neck dissection among patients with papillary thyroid cancer did not result in an improved survival benefit. Further study is warranted to better understand the extent and requirement of neck dissection among this group of patients.
颈部淋巴结转移常见于乳头状甲状腺癌。基于大规模人群研究的新证据表明，区域淋巴结转移会导致生存率降低。关于乳头状甲状腺癌的最佳初始治疗方法，文献中存在相当大的争议。我们假设总体生存受颈部受累范围和颈部清扫术的影响。
使用监测、流行病学和最终结果数据库来识别所有接受甲状腺切除术的乳头状甲状腺癌患者。排除有远处转移、无效或分期及颈部清扫术信息缺失的患者。采用Kaplan-Meier生存估计和多变量调整Cox回归模型，来估计接受选择性、改良和根治性颈部清扫术的患者与未进行颈部清扫术的患者的生存率。
本分析纳入了3439例符合条件的患者。平均年龄为45岁；76%为女性，86%为白人。2414例（70.1%）患者接受了甲状腺切除术但未进行任何颈部清扫术，而分别有19.3%、7.9%和2.7%的患者接受了选择性（有限）、改良和根治性颈部清扫术。未进行颈部清扫术、接受选择性、改良和根治性颈部清扫术的患者的五年生存率分别为96.6%、96.4%、89.5%和80.9%。在调整年龄、性别和种族后，与未进行颈部清扫术相比，改良和根治性颈部清扫术的生存风险比及95%置信区间分别为2.35（95%CI：1.46 - 3.78）和4.48（95%CI：2.57 - 7.84）（p < 0.001）。按局限性或区域性肿瘤分层后也观察到类似关联。
乳头状甲状腺癌患者进行广泛的颈部清扫术并未带来生存获益的改善。有必要进一步研究以更好地了解该组患者颈部清扫术的范围和需求。
