Mao Ling-Na, Wang Ping, Li Zhi-Yu, Wang Yong, Song Zheng-Ya
International Health Care Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
Department of General Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China.
Oncol Lett. 2015 Jan;9(1):103-107. doi: 10.3892/ol.2014.2667. Epub 2014 Nov 4.
Lymph node involvement is associated with recurrence in papillary thyroid carcinoma (PTC). The central neck compartment (level VI) lymph nodes are at the greatest risk of metastases from PTC, but the role of central neck dissection (CND) remains controversial, particularly in PTC without clinical cervical lymph node metastasis (cN). The present study aimed to identify risk factors of central cervical nodal metastasis and the safety of CND in patients with cN PTC. The current study retrospectively investigated 389 patients who had been followed up for 12.0-25.5 months after surgery, and were divided into positive or negative lymph node involvement groups according to the pathological results subsequent to this surgery. Univariate and multivariate analyses were used to study the risk factor of central node involvement. The mean tumor size was 0.71±0.35 cm (range, 0.1-2.0 cm). There was no significant difference in the rate of central lymph node involvement based on age (<45 or ≥45 years) or tumor focality (unifocal or multifocal). However, there were significant differences based on gender, extra-thyroid invasion and tumor size (P<0.05). The incidence of transient hypoparathyroidism and transient vocal cord paralysis following CND was 12.34 and 4.11%, respectively. No patient experienced permanent hypoparathyroidism or vocal cord paralysis. One patient (1/389; 0.23%) experienced disease recurrence during the follow-up. A larger tumor size and the male gender were significantly associated with the central nodal metastasis rate for cN PTC with a tumor size of <2.0 cm. CND for cN PTC patients was safe and the tumor-associated recurrence rate following CND plus total thyroidectomy was low. The present study suggests that CND should be conducted for male cN PTC patients with a larger tumor size (≥0.5 cm).
淋巴结受累与甲状腺乳头状癌（PTC）的复发相关。中央颈部区域（Ⅵ区）淋巴结是PTC转移风险最高的部位，但中央颈部淋巴结清扫术（CND）的作用仍存在争议，尤其是在无临床颈部淋巴结转移（cN）的PTC患者中。本研究旨在确定cN PTC患者中央颈部淋巴结转移的危险因素以及CND的安全性。本研究回顾性调查了389例患者，这些患者术后随访12.0 - 25.5个月，并根据术后病理结果分为淋巴结受累阳性或阴性组。采用单因素和多因素分析研究中央淋巴结受累的危险因素。平均肿瘤大小为0.71±0.35 cm（范围0.1 - 2.0 cm）。基于年龄（<45岁或≥45岁）或肿瘤灶性（单灶或多灶），中央淋巴结受累率无显著差异。然而，基于性别、甲状腺外侵犯和肿瘤大小存在显著差异（P<0.05）。CND后短暂性甲状旁腺功能减退和短暂性声带麻痹的发生率分别为12.34%和4.11%。没有患者出现永久性甲状旁腺功能减退或声带麻痹。1例患者（1/389；0.23%）在随访期间出现疾病复发。对于肿瘤大小<2.0 cm的cN PTC患者，较大的肿瘤大小和男性与中央淋巴结转移率显著相关。cN PTC患者的CND是安全的，CND加甲状腺全切除术后与肿瘤相关的复发率较低。本研究表明，对于肿瘤较大（≥0.5 cm）的男性cN PTC患者应进行CND。
