CN0 期乳头状甲状腺癌中央淋巴结转移的危险因素：一项系统评价与 Meta 分析

Risk Factors for Central Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis.

作者信息

Sun Wei, Lan Xiabin, Zhang Hao, Dong Wenwu, Wang Zhihong, He Liang, Zhang Ting, Liu Siming

机构信息

Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, Liaoning Province, China.

出版信息

PLoS One. 2015 Oct 2;10(10):e0139021. doi: 10.1371/journal.pone.0139021. eCollection 2015.

DOI:10.1371/journal.pone.0139021

PMID:26431346

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4592212/

Abstract

BACKGROUND

Central lymph node metastasis (CLNM) is common in papillary thyroid carcinoma (PTC). Prophylactic central lymph node dissection (PCLND) for patients with clinically negative central compartment lymph nodes (CN0) remains controversial. The phrase "clinically negative" is used to indicate that patients exhibited no clinical evidence of CLNM by ultrasonography (US) or computerized tomography (CT) preoperatively. In this study, we analyze the risk factors for CLNM in CN0 patients.

METHODS

The PUBMED and SCIE databases were systematically searched for works published through January 31, 2015. All of the patients included in this study underwent thyroidectomy+PCLND. Revman 5.3 software was used to analyze the data.

RESULTS

Twenty studies and 9084 patients were included in this meta-analysis. The following variables were associated with an increased risk of CLNM in CN0 patients: age < 45 years (OR = 1.59, 95% CI = 1.42-1.78, p<0.00001), male sex (OR = 1.95, 95% CI = 1.63-2.32, p<0.00001), multifocality (OR = 1.43, 95% CI = 1.22-1.67, p<0.00001), tumor size > 2 cm for PTC patients (OR = 2.98, 95% CI 2.08-4.28, p<0.00001) or tumor size > 0.5 cm for papillary thyroid microcarcinoma (PTMC) patients (OR = 2.30, 95% CI = 1.71-3.09, p<0.00001), location of the primary tumor in the central area and low pole (OR = 1.86, 95% CI = 1.48-2.33, p<0.00001), lymphovascular invasion (OR = 4.35, 95% CI = 2.24-8.46, p<0.0001), extrathyroidal extension (OR = 2.27, 95% CI = 1.76-2.94, p<0.00001), and capsular invasion (OR = 1.72, 95% CI = 1.39-2.41, p<0.00001). PTC (tumor size > 1 cm) exhibited a higher risk factor associated with CLNM than PTMC (tumor size < 1 cm) (OR = 2.83, 95% CI = 2.15-3.72, p<0.00001). Bilateral tumors (OR = 1.21, 95% CI = 0.92-1.58, p = 0.17) and lymphocytic thyroiditis (OR = 0.88, 95% CI = 0.71-1.09, p = 0.25) had no association with CLNM in CN0 patients.

CONCLUSIONS

Our systematic review identified several clinical features associated with CLNM in CN0 patients, including age, sex, multifocality, size, location, lymphovascular invasion, capsular invasion, and extrathyroidal extension. These factors should guide the application of PCLND in CN0 patients.

摘要

背景

中央区淋巴结转移（CLNM）在乳头状甲状腺癌（PTC）中很常见。对于临床中央区淋巴结阴性（CN0）的患者，预防性中央区淋巴结清扫术（PCLND）仍存在争议。“临床阴性”一词用于表明患者术前通过超声（US）或计算机断层扫描（CT）未表现出CLNM的临床证据。在本研究中，我们分析了CN0患者CLNM的危险因素。

方法

系统检索PUBMED和SCIE数据库中截至2015年1月31日发表的文献。本研究纳入的所有患者均接受了甲状腺切除术+PCLND。使用Revman 5.3软件分析数据。

结果

本荟萃分析纳入了20项研究和9084例患者。以下变量与CN0患者CLNM风险增加相关：年龄<45岁（OR = 1.59，95%CI = 1.42 - 1.78，p<0.00001）、男性（OR = 1.95，95%CI = 1.63 - 2.32，p<0.00001）、多灶性（OR = 1.43，95%CI = 1.22 - 1.67，p<0.00001）、PTC患者肿瘤大小>2 cm（OR = 2.98，95%CI 2.08 - 4.28，p<0.00001）或甲状腺微小癌（PTMC）患者肿瘤大小>0.5 cm（OR = 2.30，95%CI = 1.71 - 3.09，p<0.00001）、原发肿瘤位于中央区和下极（OR = 1.86，95%CI = 1.48 - 2.33，p<0.00001）、脉管侵犯（OR = 4.35，95%CI = 2.24 - 8.46，p<0.0001）、甲状腺外侵犯（OR = 2.27，95%CI = 1.76 - 2.94，p<0.00001）和包膜侵犯（OR = 1.72，95%CI = 1.39 - 2.41，p<0.00001）。PTC（肿瘤大小>1 cm）比PTMC（肿瘤大小<1 cm）表现出与CLNM相关的更高危险因素（OR = 2.83，95%CI = 2.15 - 3.72，p<0.00001）。双侧肿瘤（OR = 1.21，95%CI = 0.92 - 1.58，p = 0.17）和淋巴细胞性甲状腺炎（OR = 0.88，95%CI = 0.71 - 1.09，p = 0.25）与CN0患者的CLNM无关。