Department of Head and Neck Oncology, Thyroid Surgery Unit, Institut Gustave Roussy and Paris-Sud University, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France.
World J Surg. 2013 Aug;37(8):1951-8. doi: 10.1007/s00268-013-2089-3.
Prophylactic neck dissection (PND) for papillary thyroid cancer is controversial. The objective of this study was to analyze the influence of PND on the rate of retreatment.
In this retrospective case-control study, papillary thyroid carcinomas >10 mm without ultrasonographic evidence of nodal disease (cN0) were treated with total thyroidectomy (TT) or TT with bilateral central compartment PND. All received postoperative radioactive iodine ((131)I) and were followed for at least 1 year. We compared the rate of retreatment (surgery or (131)I).
Altogether, 246 patients (mean age 46 years, 78 % women) underwent TT (n = 91) or TT + PND (n = 155). The groups were similar in age, sex, tumor size, and follow-up (median 6.3 years) (p > 0.05). Overall, 11 (12 %) of the patients in the TT group underwent reoperation in the central compartment for recurrence versus 3 (2 %) in the TT + PND group (p < 0.001). There were 1.18 administrations of (131)I for the TT group versus 1.08 for the TT + PND group (p = 0.08). The average cumulative dose of (131)I was 3.9 ± 1.8 GBq for the TT group and 3.8 ± 1.3 GBq for the TT + PND group (p = 0.52). Actuarial (Kaplan-Meier) 5-year retreatment rates were 14.7 % in the TT group and 6.5 % in the TT + PND group (p = 0.01, log-rank). The rate of permanent recurrent nerve paralysis was 2 % for the TT group and 1 % for the TT + PND group (p = 0.98). The rates of permanent hypoparathyroidism were 7 versus 3 %, respectively (p = 0.12).
Five-year retreatment rates were lower in patients treated with PND, with no added permanent morbidity.
预防性颈清扫术（PND）对于甲状腺乳头状癌仍存在争议。本研究旨在分析 PND 对再次治疗率的影响。
在这项回顾性病例对照研究中，对无超声淋巴结疾病证据的 >10mm 甲状腺乳头状癌（cN0）患者行甲状腺全切除术（TT）或 TT 联合双侧中央区颈清扫术（PND）。所有患者术后均接受放射性碘（131I）治疗，并至少随访 1 年。我们比较了再次治疗（手术或 131I）的发生率。
共有 246 例患者（平均年龄 46 岁，78%为女性）接受 TT（n=91）或 TT+PND（n=155）治疗。两组患者的年龄、性别、肿瘤大小和随访时间（中位数 6.3 年）相似（p＞0.05）。TT 组中有 11 例（12%）患者因复发而在中央区再次手术，而 TT+PND 组中有 3 例（2%）（p＜0.001）。TT 组患者 131I 治疗次数为 1.18 次，TT+PND 组为 1.08 次（p=0.08）。TT 组患者 131I 的平均累积剂量为 3.9±1.8GBq，TT+PND 组为 3.8±1.3GBq（p=0.52）。TT 组和 TT+PND 组的 5 年累计再治疗率分别为 14.7%和 6.5%（p=0.01，log-rank）。TT 组和 TT+PND 组永久性喉返神经麻痹的发生率分别为 2%和 1%（p=0.98）。两组永久性甲状旁腺功能减退症的发生率分别为 7%和 3%（p=0.12）。
PND 治疗患者的 5 年再治疗率较低，且无永久性并发症增加。
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