Woo Joo Hyun, Park Ki Nam, Lee Jae Yong, Lee Seung Won
Department of Otorhinolaryngology-Head and Neck Surgery, Gachon University, Graduate School of Medicine, Gil Medical Center, Incheon, Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University School of Medicine, Bucheon Hospital, Bucheon, Korea.
PLoS One. 2016 Feb 5;11(2):e0148420. doi: 10.1371/journal.pone.0148420. eCollection 2016.
The purpose of this study was to demonstrate the incidence rates and predictive factors of superior mediastinal lymph node (SMLN) metastasis in PTC (papillary thyroid carcinoma) patients.
A prospective observational study was performed between January 2009 and January 2011. PTC patients who had tumors with a maximal diameter greater than 1 cm and clinically negative SMLNs were included in this study. Finally, a total of 217 patients who underwent total thyroidectomy with central compartment neck dissection (CND) and elective superior mediastinal lymph node dissection (SMLND), with or without modified radical neck dissection (MRND) and revisional CND, were included.
Occult SMLN metastasis was present in 15.7% (34/217). Cytological classifications of tumor, BRAFV600E mutation, Tumor size, T-stage, perithyroidal extension, lymphovascular invasion, multifocality, and paratracheal pN(+) were not predictive of SMLN metastasis (P > .05), while revision surgery, pretracheal pN(+), and multiple lateral pN(+) were associated with SMLN metastasis. There were no major complications related to SMLND. Transient and permanent hypoparathyroidism was observed in 69 cases (31.8%) and 8 cases (3.6%), respectively.
Despite clinically negative SMLN in preoperative evaluation, SMLN metastasis can be predicted for patients with a PTC tumor size larger than 1 cm, pretracheal LN metastasis, multiple lateral metastasis, and revisional surgery.
本研究旨在阐明甲状腺乳头状癌（PTC）患者上纵隔淋巴结（SMLN）转移的发生率及预测因素。
于2009年1月至2011年1月进行了一项前瞻性观察性研究。本研究纳入了最大直径大于1 cm且临床检查SMLN为阴性的PTC患者。最终，共有217例患者接受了甲状腺全切术加中央区颈淋巴结清扫术（CND）以及选择性上纵隔淋巴结清扫术（SMLND），部分患者还接受了改良根治性颈淋巴结清扫术（MRND）或再次CND。
隐匿性SMLN转移的发生率为15.7%（34/217）。肿瘤的细胞学分类、BRAFV600E突变、肿瘤大小、T分期、甲状腺周围侵犯、脉管侵犯、多灶性以及气管旁pN(+)均不能预测SMLN转移（P > 0.05），而再次手术、气管前pN(+)以及多个侧方pN(+)与SMLN转移相关。未发生与SMLND相关的严重并发症。分别有69例（31.8%）和8例（3.6%）患者出现了暂时性和永久性甲状旁腺功能减退。
尽管术前评估时临床检查SMLN为阴性，但对于肿瘤大小大于1 cm、气管前淋巴结转移、多个侧方转移以及接受再次手术的PTC患者，仍可预测SMLN转移。
