Department of Surgery, University of Wisconsin, K3/739 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA.
Oncologist. 2013;18(2):157-62. doi: 10.1634/theoncologist.2012-0240. Epub 2013 Jan 23.
Lymph node metastasis occurs in 20%-50% of patients presenting for initial treatment of papillary thyroid cancer (PTC). The significance of lymph node metastases remains controversial, and the aim of this study is to determine how the lymph node ratio (LNR) may predict the likelihood of disease recurrence.
We conducted a retrospective review of patients undergoing total thyroidectomy for PTC at our institution from 2005 to 2010. A total LNR (positive nodes to total nodes) and central lymph node ratio (cLNR) was calculated. Regression was used to determine a threshold LNR that best predicted recurrence. Multivariate logistic regression then determined the influence of LNR on recurrence while accounting for other known predictors of recurrence. Kaplan-Meier analysis and the log-rank test were used to compare differences in disease-free survival.
Of the 217 patients undergoing total thyroidectomy for PTC, 69 patients had concomitant neck dissections. Sixteen (23.2%) patients developed disease recurrence. When disease-free survival functions were compared, we found that patients with a total LNR ≥0.7 (p < .01) or a cLNR ≥0.86 (p = .04) had significantly worse disease-free survival rates than patients with ratios below these threshold values. Considering other known predictors of recurrence, we found that LNR was significantly associated with recurrence (odds ratio: 19.5, 95% confidence interval: 4.1-22.9; p < .01).
Elevated total LNR and cLNR are strongly associated with recurrence of PTC after initial operation. LNR in PTC is a tool that can be used to determine the likelihood of the patient developing recurrent disease and inform postoperative follow-up.
在接受初始治疗的甲状腺乳头状癌（PTC）患者中，有 20％-50％发生淋巴结转移。淋巴结转移的意义仍存在争议，本研究旨在确定淋巴结比率（LNR）如何预测疾病复发的可能性。
我们对 2005 年至 2010 年在我院接受甲状腺全切除术治疗 PTC 的患者进行了回顾性研究。计算总 LNR（阳性淋巴结与总淋巴结的比值）和中央淋巴结比率（cLNR）。使用回归确定最佳预测复发的 LNR 阈值。然后，多变量逻辑回归确定 LNR 对复发的影响，同时考虑了复发的其他已知预测因素。使用 Kaplan-Meier 分析和对数秩检验比较无病生存率的差异。
在 217 例接受甲状腺全切除术治疗 PTC 的患者中，有 69 例同时进行了颈部清扫术。16 例（23.2％）患者发生疾病复发。当比较无病生存函数时，我们发现总 LNR≥0.7（p<0.01）或 cLNR≥0.86（p=0.04）的患者无病生存率明显低于比值低于这些阈值的患者。考虑到复发的其他已知预测因素，我们发现 LNR 与复发显著相关（优势比：19.5，95％置信区间：4.1-22.9；p<0.01）。
初始手术后，升高的总 LNR 和 cLNR 与 PTC 的复发密切相关。LNR 是一种可用于确定患者发生复发性疾病可能性并为术后随访提供信息的工具。
