Lang Brian Hung-Hin, Chan Diane T Y, Wong Kai Pun, Wong Kandy K C, Wan Koon Yat
Department of Surgery, The University of Hong Kong, Hong Kong SAR, China,
Ann Surg Oncol. 2014 Dec;21(13):4181-7. doi: 10.1245/s10434-014-3872-6. Epub 2014 Jul 3.
Prophylactic central neck dissection (pCND) at the time of the total thyroidectomy (TT) remains controversial in clinically nodal-negative (cN0) papillary thyroid carcinoma. Our study was designed to examine the predictive factors and pattern of locoregional recurrence (LRR) after pCND in the context of the postoperative stimulated Tg (sTg) level.
A total of 341 patients who underwent TT and unilateral pCND were analyzed. Patients with an identifiable lesion on ultrasonography or whole-body scan within 6 months of surgery were excluded. LRR was defined as an identifiable lesion on USG, which was later confirmed by cytology/histology. Preablation sTg level was taken 2 months after surgery, whereas postablation sTg level was taken 8 months after surgery. Cox regression was used in the univariate and multivariate analyses to identify significant independent factors for LRR.
After a follow-up of 66.6 ± 38.6 months, 14 (4.1 %) suffered from LRR. The duration to first LRR was 36.4 ± 21.7 months. The estimated 5- and 10-year LRR rates were 5.1 and 6.1 %, respectively. Of these 14 LRR, 3 (21.4 %) involved the central compartment alone, 9 (64.3 %) involved the lateral compartment alone, and 2 (14.3 %) involved both central and lateral compartments. After adjusting for other clinicopathological factors, postablation sTg level ≥ 1 µg/L (hazard ratio 265.109, 95 % confidence interval 1.132-62075.644, p = 0.045) was the only independent predictor of LRR.
Annualized risk of LRR after pCND was approximately 1 % in the first 5 years and 0.2 % in the subsequent 5 years. Most (78.6 %) LRRs involved the lateral compartment. Postablation sTg ≥ 1 µg/L significantly predicted risk of LRR.
在全甲状腺切除术（TT）时进行预防性中央区颈淋巴结清扫（pCND）在临床淋巴结阴性（cN0）的甲状腺乳头状癌中仍存在争议。我们的研究旨在探讨在术后刺激甲状腺球蛋白（sTg）水平的背景下，pCND后局部区域复发（LRR）的预测因素和模式。
共分析了341例行TT和单侧pCND的患者。排除术后6个月内超声或全身扫描发现可识别病变的患者。LRR定义为超声检查发现的可识别病变，随后经细胞学/组织学证实。术前消融sTg水平在术后2个月测定，而术后消融sTg水平在术后8个月测定。采用Cox回归进行单因素和多因素分析，以确定LRR的显著独立因素。
随访66.6±38.6个月后，14例（4.1%）发生LRR。首次LRR的时间为36.4±21.7个月。估计的5年和10年LRR率分别为5.1%和6.1%。在这14例LRR中，3例（21.4%）仅累及中央区，9例（64.3%）仅累及侧方区，2例（14.3%）累及中央区和侧方区。在调整其他临床病理因素后，术后消融sTg水平≥1μg/L（风险比265.109，95%置信区间1.132 - 62075.644，p = 0.045）是LRR的唯一独立预测因素。
pCND后LRR的年化风险在最初5年约为1%，在随后5年约为0.2%。大多数（78.6%）LRR累及侧方区。术后消融sTg≥1μg/L显著预测LRR风险。
