Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle (Saale), Germany.
J Clin Endocrinol Metab. 2012 Dec;97(12):4375-82. doi: 10.1210/jc.2012-1257. Epub 2012 Sep 27.
A prognostic classification system based on aggregate numbers of lymph node metastases may better estimate the risk of distant metastasis.
This investigation sought to evaluate a papillary thyroid cancer (PTC) patient's risk of distant metastasis.
This was a retrospective analysis.
The setting was a tertiary referral center.
Included were 972 PTC patients.
The intervention was compartment-oriented surgery.
The main outcome measure was lung, bone, and liver metastasis.
Eighty-seven (9.0%) of the 972 PTC patients had distant metastases to lung (79 patients), bone (16 patients), liver (two patients), brain and skin (one patient each). For distant metastasis, more than 20 lymph node metastases had a specificity of 90.8% and a negative predictive value of 92.7%, whereas sensitivity and positive predictive value were low (27.6 and 22.9%). On multivariate logistic regression, 1-5, 6-10, and 11-20 involved nodes denoted a moderate risk of lung metastasis [odds ratio (OR), 9.9, 10.6, and 13.8; P ≤ 0.004], whereas more than 20 involved nodes indicated a high risk of lung metastasis (OR, 25.0; P < 0.001). Mediastinal lymph node metastasis carried a moderate risk of lung metastasis (OR, 7.5; P = 0.001). When these numeric categories of lymph node metastases were exchanged for current tumor node metastasis (TNM) N categories, the OR decreased from 25.0 (for > 20 lymph node metastases) to 16.4 (N1b), and from 9.9-13.8 (for 1-20 lymph node metastases) to 4.7 (N1a).
In PTC, categories of 0, 1-20, and more than 20 lymph node metastases correlate better with lung metastasis than current TNM N categories N0, N1a, and N1b.
基于淋巴结转移总数的预后分类系统可能更好地估计远处转移的风险。
本研究旨在评估甲状腺乳头状癌（PTC）患者发生远处转移的风险。
回顾性分析。
三级转诊中心。
纳入 972 例 PTC 患者。
采用隔室导向手术。
肺、骨和肝转移。
972 例 PTC 患者中，87 例（9.0%）发生远处转移至肺（79 例）、骨（16 例）、肝（2 例）、脑和皮肤（各 1 例）。对于远处转移，超过 20 个淋巴结转移的特异性为 90.8%，阴性预测值为 92.7%，而敏感性和阳性预测值较低（分别为 27.6%和 22.9%）。多变量逻辑回归分析显示，1-5、6-10 和 11-20 个受累淋巴结表示中等程度的肺转移风险[比值比（OR）分别为 9.9、10.6 和 13.8；P ≤ 0.004]，而超过 20 个受累淋巴结则表示高风险的肺转移（OR，25.0；P < 0.001）。纵隔淋巴结转移表示有中等程度的肺转移风险（OR，7.5；P = 0.001）。当这些淋巴结转移的数字类别被替换为当前的肿瘤淋巴结转移（TNM）N 类别时，OR 从 25.0（超过 20 个淋巴结转移）降至 16.4（N1b），从 9.9-13.8（1-20 个淋巴结转移）降至 4.7（N1a）。
在 PTC 中，0、1-20 和超过 20 个淋巴结转移的类别与肺转移的相关性优于当前的 TNM N 类别 N0、N1a 和 N1b。
