Chéreau Nathalie, Buffet Camille, Trésallet Christophe, Tissier Frédérique, Leenhardt Laurence, Menegaux Fabrice
Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
Department of Nuclear Medicine, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
Surgery. 2016 Mar;159(3):755-62. doi: 10.1016/j.surg.2015.08.033. Epub 2015 Oct 2.
Lateral neck lymph node (LN) metastases (N1b) have been identified as independent risk factors of recurrence in patients with papillary thyroid carcinoma (PTC).
This study aimed to determine the predictive factors of recurrence in N1b PTC patients and to clarify the postoperative event patterns.
All patients who underwent operation for N1b PTC between 1978 and 2012 were reviewed. The median follow-up period was 6.5 years.
In total, 344 N1b patients were included. Twenty-four patients (7%) were lost to long-term follow-up. Among the remaining 320 patients, the mean (± SD) follow-up time was 8.9 ± 8.8 years (median, 6.5; range, 2-36.4). Eighty-two patients (26%) presented with lymph node recurrence (LR). Multivariate analyses showed that LN metastases with extracapsular extension and the LN ratio (ratio between the number of N1 and number of resected LN) in the lateral compartment were independent predictors of recurrent disease. The median time to reoperation was 19 months (range, 3-173), with 79% of reoperations occurring within 2 years after the initial thyroidectomy. Reoperations for LR (75 patients) were performed in 76% of the patients with a focused minimal access approach or selective LN dissection. After curative reoperative surgery for recurrence, complications occurred in 6 patients (8%), including a 1% permanent complication rate.
Extranodal extension of LN metastases and the LN ratio in the lateral compartment are prognostic factors for recurrence. In most cases, reoperation for LR can be performed with a focused minimal access approach, with a low morbidity rate.
侧颈部淋巴结转移（N1b）已被确定为甲状腺乳头状癌（PTC）患者复发的独立危险因素。
本研究旨在确定N1b PTC患者复发的预测因素，并阐明术后事件模式。
回顾了1978年至2012年间接受N1b PTC手术的所有患者。中位随访期为6.5年。
共纳入344例N1b患者。24例患者（7%）失访。在其余320例患者中，平均（±标准差）随访时间为8.9±8.8年（中位数，6.5；范围，2 - 36.4）。82例患者（26%）出现淋巴结复发（LR）。多因素分析显示，侧方区域伴有包膜外侵犯的淋巴结转移以及淋巴结比率（N1数量与切除淋巴结数量之比）是疾病复发的独立预测因素。再次手术的中位时间为19个月（范围，3 - 173），79%的再次手术发生在初次甲状腺切除术后2年内。76%的LR再次手术患者采用了聚焦微创入路或选择性淋巴结清扫术。复发的根治性再次手术后，6例患者（8%）出现并发症，永久性并发症发生率为1%。
淋巴结转移的包膜外侵犯和侧方区域的淋巴结比率是复发的预后因素。在大多数情况下，LR再次手术可采用聚焦微创入路，发病率较低。
