O'Neill Christine J, Coorough Nicholas, Lee James C, Clements Joshua, Delbridge Leigh W, Sippel Rebecca, Sywak Mark S, Chen Herb, Sidhu Stan B
Endocrine Surgical Unit, The University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2014 Apr;84(4):240-4. doi: 10.1111/ans.12045. Epub 2013 Jan 14.
The prognostic influence of lateral neck nodal metastases present at the time of diagnosis of papillary thyroid cancer (PTC) remains controversial. This study aims to document disease outcomes and nodal recurrence rates in such patients.
Patients with PTC and lateral neck nodal metastases who underwent concurrent total thyroidectomy, central and lateral compartment neck dissection between 2000 and 2010 were identified from the prospectively maintained surgical databases of The University of Sydney and University of Wisconsin Endocrine Surgical Units. Disease outcomes and nodal recurrence rates were compared at 12 months post-operatively and in longer-term follow-up.
During this 11-year period, 121 patients were identified. Mean age was 45 years; 58% were female and 98% underwent post-operative radioactive iodine ablation. At a median follow-up of 31 months (range 12-140), there were no disease-specific deaths and disease-free survival (defined by stimulated serum thyroglobulin (Tg) < 2.0 μg/L, negative clinical and radiological examination) was 66%. Of the 50 patients with persistently elevated Tg measured 12 months post-operatively, 15 developed clinical lateral neck nodal recurrence. All have undergone re-operative surgery. Elevated stimulated Tg at 12 months post-operatively and a nodal ratio of >30% were significantly associated with an increased risk of lateral neck nodal recurrence.
With total thyroidectomy, formal compartmental neck dissection and radioactive iodine treatment, disease-free survival can be achieved in the majority of patients with PTC and synchronous lateral neck nodal metastases. A persistently elevated Tg post-operatively and a high ratio of metastatic nodes identify patients at increased risk of locoregional recurrence.
甲状腺乳头状癌（PTC）诊断时存在侧颈淋巴结转移对预后的影响仍存在争议。本研究旨在记录此类患者的疾病转归和淋巴结复发率。
从悉尼大学和威斯康星大学内分泌外科前瞻性维护的手术数据库中，识别出2000年至2010年间接受同期全甲状腺切除术、中央区和侧颈区淋巴结清扫术的PTC伴侧颈淋巴结转移患者。在术后12个月和长期随访中比较疾病转归和淋巴结复发率。
在这11年期间，共识别出121例患者。平均年龄为45岁；58%为女性，98%接受了术后放射性碘消融治疗。中位随访31个月（范围12 - 140个月），无疾病特异性死亡，无病生存率（定义为刺激后血清甲状腺球蛋白（Tg）<2.0μg/L，临床及影像学检查阴性）为66%。术后12个月Tg持续升高的50例患者中，15例出现临床侧颈淋巴结复发。所有患者均接受了再次手术。术后12个月刺激后Tg升高和淋巴结比例>30%与侧颈淋巴结复发风险增加显著相关。
通过全甲状腺切除术、规范的分区颈淋巴结清扫术和放射性碘治疗，大多数PTC伴同步侧颈淋巴结转移患者可实现无病生存。术后Tg持续升高和转移淋巴结比例高可识别局部区域复发风险增加的患者。
