Department of General Surgery, Affiliated Union Hospital, Tongji Medical College, Wuhan, China.
Ann Surg Oncol. 2013 Mar;20(3):746-52. doi: 10.1245/s10434-012-2654-2. Epub 2012 Sep 13.
To identify the subgroup of high-risk papillary thyroid microcarcinoma (PTMC) inclined to lymph node metastasis (LNM).
Patients who underwent total thyroidectomy with central neck dissection and had a pathologic diagnosis of PTMC between 2003 and 2010 at Wuhan Union Hospital were identified. The frequency of LNM was retrospectively analyzed according to the clinicopathological features. For multifocal lesions, total tumor diameter (TTD) was calculated as the sum of the maximal diameter of each lesion. Last, a meta-analysis was performed with respect to multifocality and LNM in the PTMCs.
The proportion of LNM was similar between multifocal PTMCs with TTD ≤ 1 cm and unifocal tumors with diameter ≤ 1 cm (37.5 vs. 30%, P = 0.463). LNM frequency was also similar between multifocal PTMCs with 1 < TTD ≤ 2 cm (TTD greater than 1 cm but less than or equal to 2 cm) and unifocal tumors with 1 < diameter ≤ 2 cm (56.8 vs. 64.9%, P = 0.330). However, LNM frequency was significantly higher in multifocal PTMCs with TTD > 1 cm than unifocal tumors with diameter ≤ 1 cm (60.4 vs. 30%, P < 0.001). A meta-analysis of nine publications plus our own data with a total 1,586 PTMCs demonstrated that multifocality was significantly associated with LNM risk (odds ratio 1.9, 95% confidence interval 1.5-2.4).
Multifocal PTMC with TTD > 1 cm has a similar risk of LNM as a clinical papillary cancer. Routine central neck dissection is recommended in this subgroup of patients.
确定倾向于发生淋巴结转移（LNM）的高危甲状腺微小乳头状癌（PTMC）亚组。
回顾性分析 2003 年至 2010 年间在武汉协和医院行甲状腺全切除术和中央区淋巴结清扫术且病理诊断为 PTMC 的患者。根据临床病理特征分析 LNM 的发生率。对于多灶性病变，总肿瘤直径（TTD）计算为每个病变最大直径的总和。最后，对 PTMC 的多灶性和 LNM 进行了荟萃分析。
TTD≤1cm 的多灶性 PTMC 和直径≤1cm 的单灶性肿瘤之间 LNM 的比例相似（37.5% vs. 30%，P=0.463）。TTD 为 1cm<1cm<2cm（TTD 大于 1cm 但小于或等于 2cm）的多灶性 PTMC 和直径为 1cm<1cm<2cm（56.8% vs. 64.9%，P=0.330）的多灶性 PTMC 之间 LNM 的频率也相似。然而，TTD>1cm 的多灶性 PTMC 与直径≤1cm 的单灶性肿瘤相比，LNM 的频率显著更高（60.4% vs. 30%，P<0.001）。对 9 篇文献加上我们自己的数据进行荟萃分析，共纳入 1586 例 PTMC 患者，结果表明多灶性与 LNM 风险显著相关（优势比 1.9，95%置信区间 1.5-2.4）。
TTD>1cm 的多灶性 PTMC 发生 LNM 的风险与临床甲状腺癌相似。建议对这组患者行常规中央区淋巴结清扫术。
