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放射性碘在甲状腺乳头状癌偶发N1a期疾病管理中的作用

Role of RAI in the management of incidental N1a disease in papillary thyroid cancer.

作者信息

Wang Laura Y, Palmer Frank L, Migliacci Jocelyn C, Nixon Iain J, Shaha Ashok R, Shah Jatin P, Tuttle Robert Michael, Patel Snehal G, Ganly Ian

机构信息

Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Department of Medicine, Endocrine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

出版信息

Clin Endocrinol (Oxf). 2016 Feb;84(2):292-295. doi: 10.1111/cen.12828. Epub 2015 Jul 3.

Abstract

BACKGROUND

Following total thyroidectomy (TT) for papillary thyroid cancer (PTC), pathological assessment can occasionally reveal incidental perithyroidal lymph nodes (LNs) with occult metastases. These cN0pN1a patients often receive radioactive iodine (RAI) therapy for this indication alone. The aim of this study was to determine the central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment.

METHODS

An institutional database of 3664 previously untreated patients with differentiated thyroid cancer operated between 1986 and 2010 was reviewed. A total of 232 pT1-3 patients managed with TT and no neck dissection were subsequently found to have incidental level 6 LNs on pathology. Patients with other indications for RAI, such as extrathyroidal extension and close or positive margins, were excluded. One hundred and four patients remained for analysis. Kaplan-Meier method was used to determine central neck LN recurrence-free survival (RFS).

RESULTS

The median age of the cohort was 40 years (range 17-83). The median follow-up was 53 months (range 1-211). The median number of positive LNs removed and maximum LN diameter were 1 (range 1-8) and 5 mm (range 1-16 mm), respectively. A total of 67 (64%) patients had adjuvant RAI and 37 (36%) did not. Patients with vascular invasion (P = 0·01), LNs >2 mm (P = 0·07) and >2 positive nodes (P = 0·06) were more likely to be selected for adjuvant RAI therapy. Patients without RAI therapy had similar 5-year central neck LN RFS compared to those treated with RAI: 96·2% vs 94·6%, respectively (P = 0·92).

CONCLUSION

There is no difference in the 5-year central compartment nodal recurrence-free survival in patients treated without RAI compared to those who received RAI treatment.

摘要

背景

在因乳头状甲状腺癌(PTC)行全甲状腺切除术(TT)后,病理评估偶尔会发现甲状腺周围淋巴结(LNs)有隐匿性转移。这些cN0pN1a患者常仅因这一指征接受放射性碘(RAI)治疗。本研究的目的是确定未接受RAI治疗的患者与接受RAI治疗的患者相比,中央区淋巴结无复发生存率。

方法

回顾了一个机构数据库,该数据库包含1986年至2010年间3664例未经治疗的分化型甲状腺癌患者。随后发现共有232例接受TT且未行颈部清扫的pT1-3患者在病理检查中发现有6区LNs。排除有其他RAI指征的患者,如甲状腺外侵犯、切缘接近或阳性。104例患者留作分析。采用Kaplan-Meier法确定中央区颈部淋巴结无复发生存率(RFS)。

结果

该队列的中位年龄为40岁(范围17-83岁)。中位随访时间为53个月(范围1-211个月)。切除的阳性淋巴结中位数和最大淋巴结直径分别为1个(范围1-8个)和5mm(范围1-16mm)。共有67例(64%)患者接受辅助性RAI治疗,37例(36%)未接受。有血管侵犯(P = 0.01)、淋巴结>2mm(P = 0.07)和>2个阳性淋巴结(P = 0.06)的患者更有可能被选择接受辅助性RAI治疗。未接受RAI治疗的患者与接受RAI治疗的患者相比,5年中央区颈部淋巴结RFS相似:分别为96.2%和94.6%(P = 0.92)。

结论

未接受RAI治疗的患者与接受RAI治疗的患者相比,5年中央区淋巴结无复发生存率无差异。

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