Liu Jie, Xu Zhengang, Li Zhengjiang, Zhang Zongmin, Tang Pingzhang, Liu Shaoyan
Department of Head and Neck Surgical Oncology, Chinese Academy of Medical Science, Cancer Hospital, Beijing, China.
, No.17 Panjiayuan Nanli, Chaoyang District, Beijing, China.
Eur Arch Otorhinolaryngol. 2015 Dec;272(12):3801-4. doi: 10.1007/s00405-014-3453-0. Epub 2014 Dec 24.
The treatment strategy for clinically negative lymph nodes of papillary thyroid carcinoma is controversial. We report the long-term outcomes of a series of cases treated with thyroidectomy without prophylactic central neck dissection. We reviewed 1,397 cases with papillary thyroid carcinoma treated at our institution between 1991 and 2000. One hundred and seventy-two newly diagnosed cases underwent observation for cN0 central neck lymph nodes. Regional recurrence of the ipsilateral side including central compartment and the lateral neck which needs reoperation was considered as key point for analysis. With a mean follow-up of 96.4 months (34-204 months), the overall 10-year disease-specific and recurrence-free survival rates were 99 and 86 %, respectively. The recurrence and reoperation rates of the central compartment were 3 % (5/172) and 4 % (7/172), respectively. Univariate analysis showed that extrathyroidal extension was associated with regional recurrence (99 vs. 82 %; p = 0.002). Central compartment observation is safe in cN0 cases with papillary thyroid carcinoma, particularly in those without extrathyroidal extension.
甲状腺乳头状癌临床阴性淋巴结的治疗策略存在争议。我们报告了一系列未行预防性中央区颈淋巴结清扫的甲状腺切除术治疗病例的长期结果。我们回顾了1991年至2000年间在我院接受治疗的1397例甲状腺乳头状癌病例。172例新诊断病例对cN0中央区颈淋巴结进行了观察。同侧区域复发，包括需要再次手术的中央区和侧颈部，被视为分析的重点。平均随访96.4个月（34 - 204个月），总体10年疾病特异性生存率和无复发生存率分别为99%和86%。中央区的复发率和再次手术率分别为3%（5/172）和4%（7/172）。单因素分析显示，甲状腺外侵犯与区域复发相关（99%对82%；p = 0.002）。对于甲状腺乳头状癌cN0病例，尤其是那些没有甲状腺外侵犯的病例，中央区观察是安全的。
