Kim Seo Ki, Park Inhye, Woo Jung-Woo, Lee Jun Ho, Choe Jun-Ho, Kim Jung-Han, Kim Jee Soo
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea.
Ann Surg Oncol. 2016 Sep;23(9):2866-73. doi: 10.1245/s10434-016-5225-0. Epub 2016 Apr 13.
Because lymph node (LN) metastasis has been proven to be a predictor for locoregional recurrence (LRR) in papillary thyroid microcarcinoma (PTMC), better knowledge about the predictors for LN metastasis in PTMC is required.
We retrospectively reviewed 5656 PTMC patients who underwent total thyroidectomy and central neck dissection and/or lateral neck dissection between January 1997 and June 2015.
Male gender (adjusted odds ratio [OR] 2.332), conventional variant (adjusted OR 4.266), tumor size >0.5 cm (adjusted OR 1.753), multiplicity (adjusted OR 1.168), bilaterality (adjusted OR 1.177), and extrathyroidal extension (ETE) (adjusted OR 1.448) were independent predictors for high prevalence of central LN metastasis (CLNM), whereas per 10-year age increment (adjusted OR 0.760) and chronic lymphocytic thyroiditis (adjusted OR 0.791) were independent predictors for low prevalence of CLNM. In addition, male gender (adjusted OR 1.489), tumor size >0.5 cm (adjusted OR 1.295), multiplicity (adjusted OR 1.801), ETE (adjusted OR 1.659), and CLNM (adjusted OR 4.359) were independent predictors for high prevalence of lateral LN metastasis (LLNM), whereas per 10-year age increment (adjusted OR 0.838) was an independent predictor for low prevalence of LLNM. There was a statistically significant difference in LRR with regard to nodal stage (p < 0.001).
Meticulous perioperative evaluation of LN metastasis is required for PTMC patients with the above predictors.
由于淋巴结（LN）转移已被证明是甲状腺微小乳头状癌（PTMC）局部区域复发（LRR）的一个预测指标，因此需要更好地了解PTMC中LN转移的预测因素。
我们回顾性分析了1997年1月至2015年6月期间接受全甲状腺切除术及中央区颈淋巴结清扫和/或侧颈淋巴结清扫的5656例PTMC患者。
男性（校正优势比[OR] 2.332）、经典型（校正OR 4.266）、肿瘤大小>0.5 cm（校正OR 1.753）、多灶性（校正OR 1.168）、双侧性（校正OR 1.177）和甲状腺外侵犯（ETE）（校正OR 1.448）是中央区LN转移（CLNM）高发生率的独立预测因素，而每增加10岁（校正OR 0.760）和慢性淋巴细胞性甲状腺炎（校正OR 0.791）是CLNM低发生率的独立预测因素。此外，男性（校正OR 1.489）、肿瘤大小>0.5 cm（校正OR 1.295）、多灶性（校正OR 1.801）、ETE（校正OR 1.659）和CLNM（校正OR 4.359）是侧颈LN转移（LLNM）高发生率的独立预测因素，而每增加10岁（校正OR 0.838）是LLNM低发生率的独立预测因素。LRR在淋巴结分期方面存在统计学显著差异（p < 0.001）。
对于具有上述预测因素的PTMC患者，需要进行细致的围手术期LN转移评估。
