Nixon I J, Wang L Y, Ganly I, Patel S G, Morris L G, Migliacci J C, Tuttle R M, Shah J P, Shaha A R
Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.
Department of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, USA.
Br J Surg. 2016 Feb;103(3):218-25. doi: 10.1002/bjs.10036. Epub 2015 Oct 29.
The role of prophylactic central neck dissection (CND) in the management of papillary thyroid cancer (PTC) is controversial. This report describes outcomes of an observational approach in patients without clinical evidence of nodal disease in PTC.
All patients who had surgery between 1986 and 2010 without CND for PTC were identified. All patients had careful clinical assessment of the central neck during preoperative and perioperative evaluation, with any suspicious nodal tissue excised for analysis. The cohort included patients in whom lymph nodes had been removed, but no patient had undergone a formal neck dissection. Recurrence-free survival (RFS), central neck RFS and disease-specific survival (DSS) were calculated using the Kaplan-Meier method.
Of 1798 patients, 397 (22.1 per cent) were men, 1088 (60.5 per cent) were aged 45 years or more, and 539 (30.0 per cent) had pT3 or pT4 disease. Some 742 patients (41.3 per cent) received adjuvant treatment with radioactive iodine. At a median follow-up of 46 months the 5-year DSS rate was 100 per cent. Five-year RFS and central neck RFS rates were 96.6 and 99.1 per cent respectively.
Observation of the central neck is safe and should be recommended for all patients with PTC considered before and during surgery to be free of central neck metastasis.
预防性中央区颈淋巴结清扫术（CND）在甲状腺乳头状癌（PTC）治疗中的作用存在争议。本报告描述了对无PTC区域淋巴结疾病临床证据患者采用观察性方法的结果。
确定1986年至2010年间所有因PTC未行CND而接受手术的患者。所有患者在术前和围手术期评估时均对中央区颈部进行了仔细的临床评估，切除任何可疑的淋巴结组织进行分析。该队列包括已切除淋巴结的患者，但没有患者接受过正式的颈部清扫术。采用Kaplan-Meier法计算无复发生存率（RFS）、中央区颈部RFS和疾病特异性生存率（DSS）。
1798例患者中，男性397例（22.1%），年龄45岁及以上者1088例（60.5%），pT3或pT4期疾病患者539例（30.0%）。约742例患者（41.3%）接受了放射性碘辅助治疗。中位随访46个月时，5年DSS率为100%。5年RFS和中央区颈部RFS率分别为96.6%和99.1%。
对中央区颈部进行观察是安全的，对于所有术前和术中考虑无中央区颈部转移的PTC患者均应推荐。
