Thyroid and Endocrine Surgery Department, Gachon University Gil Hospital, 1198, Guwol-dong, Namdong-Gu, Inchon, Republic of Korea,
World J Surg. 2013 Nov;37(11):2594-9. doi: 10.1007/s00268-013-2157-8.
Delphian lymph node (DLN) metastasis has long been considered a prognostic marker of head and neck malignancy. These days, the significance of DLN in thyroid cancer has come to the fore. The objective of the present study was to evaluate the clinical significance of DLN metastasis in patients with papillary thyroid cancer (PTC).
The study was carried out between July 2009 and December 2011, and DLN was detected in 245 of 898 PTC patients who underwent total thyroidectomy and bilateral central compartment neck dissection. In those 245 patients DLN status was correlated with clinical and pathologic factors, including age, gender, tumor size, extrathyroidal extension (ETE), lymphovascular invasion (LVI), and central and lateral nodal metastasis.
DLN metastasis was found in 20 % of the patients studied (49 of 245), and DLN metastasis was correlated with tumor size, multicentricity, bilaterality, and LVI excluding ETE (all p < 0.05). The proportion of male patients was higher in the DLN metastasis positive group than in the DLN metastasis negative group (34.7 vs. 13.3 %; p < 0.05). Most of the patients (95.9 %) with DLN metastasis had other central neck node metastasis, and the metastatic central lymph node ratio was higher (0.38 ± 0.23 versus 0.09 ± 0.16; p < 0.001) and lateral neck node metastasis was more common (2.6 vs. 32.7 % <0.001) than in patients without DLN metastasis. For central and lateral compartment nodal metastasis, DLN status had sensitivity, specificity, positive and negative predictive values of 100, 37.4, 58.1, and 100 %, and 85.3, 76.2, 97.4, and 32.7 %, respectively. Multivariate analysis showed that the factors affecting DLN involvement were tumor size and LVI. Patients with positive DLN were ~1.6 times more likely to have further central compartment disease and 3.6 times more likely to have lateral compartment disease.
DLN metastasis in patients with PTC is related to a number of poor prognostic factors. Furthermore DLN involvement implies that the patients are predicted to have heavy burden of central neck node metastasis and are more likely to have further lateral neck node metastasis. It is recommended that DLN is evaluated and dissected in all patients with thyroid cancer. If DLN metastasis is suspected, the surgeon should thoroughly dissect the central neck compartment and pay particular attention to the lateral lymph node compartments.
Delphian 淋巴结 (DLN) 转移一直被认为是头颈部恶性肿瘤的预后标志物。如今，DLN 在甲状腺癌中的意义已经凸显出来。本研究的目的是评估 DLN 转移在甲状腺乳头状癌 (PTC) 患者中的临床意义。
本研究于 2009 年 7 月至 2011 年 12 月进行，对 898 例接受甲状腺全切除术和双侧中央区颈部淋巴结清扫术的 PTC 患者中的 245 例进行了 DLN 检测。在这 245 例患者中，DLN 状态与临床和病理因素相关，包括年龄、性别、肿瘤大小、甲状腺外侵犯 (ETE)、血管淋巴管侵犯 (LVI)、中央和侧方淋巴结转移。
20%的患者 (49/245) 发现 DLN 转移，DLN 转移与肿瘤大小、多中心性、双侧性和不包括 ETE 的 LVI 相关 (均 p<0.05)。DLN 转移阳性组男性患者比例高于 DLN 转移阴性组 (34.7%比 13.3%；p<0.05)。大多数 (95.9%) 有 DLN 转移的患者有其他中央颈部淋巴结转移，转移的中央淋巴结比率更高 (0.38±0.23 比 0.09±0.16；p<0.001)，侧方颈部淋巴结转移更常见 (2.6%比 32.7%<0.001)。对于中央和侧方区淋巴结转移，DLN 状态的敏感性、特异性、阳性预测值和阴性预测值分别为 100%、37.4%、58.1%和 100%，85.3%、76.2%、97.4%和 32.7%。多因素分析显示，影响 DLN 受累的因素是肿瘤大小和 LVI。DLN 阳性的患者发生进一步中央区疾病的可能性约为 1.6 倍，发生侧方区疾病的可能性约为 3.6 倍。
PTC 患者的 DLN 转移与多种不良预后因素有关。此外，DLN 受累表明患者存在中央颈部淋巴结转移的大量负担，并且更有可能发生进一步的侧方颈部淋巴结转移。建议对所有甲状腺癌患者评估和清扫 DLN。如果怀疑 DLN 转移，外科医生应彻底清扫中央颈部间隙，并特别注意侧方淋巴结间隙。
