Zhang Ming, Wei Tao, Li Zhi-hui, Chen Rui, Gong Ri-xiang, Li Jie-qing, Zhu Jing-qiang, Peng Yu-lan, Ma Bu-yun, Gou Ju-xiang, Lin Xiao-yan
Department of Thyroid and Breast, West China Hospital of Sichuan University, Chengdu 610041, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2012 Jul;47(7):565-70.
To study the related factors of central lymph node (CLN) metastasis in papillary thyroid carcinoma (PTC),the indications and the extent of central neck dissection (CND).
A total of 153 cases treated between Jan. 2009 and Dec. 2010 was analysed retrospectively. Of the cases 28 males and 125 cases females, with a mean age of (44 ± 14) years. T1, T2, and T3 diseases accounted for 51, 10 and 81 cases, respectively; I, II, III and IV diseases for 88, 3, 26 and 36 cases, respectively. Multifocal tumors were found in 63 cases. The related clinicopathologic factors were analyzed, including sex, age, tumor size, extrathyroidal extension, and multifocal tumor.
All the cases had total/near total thyroidectomy and CND, of them 64 cases had unilateral neck dissection and 18 cases had bilateral neck dissection. CLN metastases existed in 68.6% (105/153) cases, 37.2% (57/153) for unilateral and 31.4% (48/153) for bilateral respectively. The rates of CLN metastasis were 86.6% (71/82) in cN1 cases and 47.9% (34/71) cN0 cases, respectively,and the rates of bilateral CLN metastases were 45.1% (37/82) in cN1 cases and 15.5% (11/71) in cN0 cases. Multivariate analysis showed that extrathyroidal extension (P = 0.002, OR = 3.502) was an independent risk factor for CLN metastasis and that lateral neck lymph node metastasis (P = 0.028, OR = 3.080), surrounding tissue invasion (P = 0.014, OR = 3.113), and maximum tumor diameter greater than 1 cm (P = 0.012, OR = 3.732) were independent risk factors for bilateral CLN metastases.
It is indicated that ipsilateral CND should be obligatory for PTC. Intraoperative frozen section examination should be routine. Bilateral CND should be conducted when ipsilateral CLN metastases accompanied by one of following issues such as more invasive tumor (surrounding tissue invasion, T3 or T4 disease), maximum tumor diameter greater than 1 cm, and lateral neck lymph node metastasis.
探讨甲状腺乳头状癌（PTC）中央区淋巴结（CLN）转移的相关因素、中央区颈清扫术（CND）的指征及范围。
回顾性分析2009年1月至2010年12月期间收治的153例患者。其中男性28例，女性125例，平均年龄（44±14）岁。T1、T2和T3期疾病分别为51例、10例和81例；Ⅰ、Ⅱ、Ⅲ和Ⅳ期疾病分别为88例、3例、26例和36例。63例发现多灶性肿瘤。分析相关临床病理因素，包括性别、年龄、肿瘤大小、甲状腺外侵犯及多灶性肿瘤。
所有患者均行甲状腺全切除或近全切除及CND，其中64例行单侧颈清扫，18例行双侧颈清扫。CLN转移率为68.6%（105/153），单侧转移率为37.2%（57/153），双侧转移率为31.4%（48/153）。cN1病例中CLN转移率为86.6%（71/82），cN0病例中为47.9%（34/71）；cN1病例中双侧CLN转移率为45.1%（37/82），cN0病例中为15.5%（11/71）。多因素分析显示，甲状腺外侵犯（P = 0.002，OR = 3.502）是CLN转移的独立危险因素，侧颈淋巴结转移（P = 0.028，OR = 3.080）、周围组织侵犯（P = 0.014，OR = 3.113）及最大肿瘤直径大于1 cm（P = 0.012，OR = 3.732）是双侧CLN转移的独立危险因素。
提示PTC患者应常规行患侧CND，术中应常规行冰冻切片检查。当患侧CLN转移合并以下情况之一时，如肿瘤侵袭性更强（周围组织侵犯、T3或T4期疾病）、最大肿瘤直径大于1 cm及侧颈淋巴结转移，应行双侧CND。
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