Lin Dao-Zhe, Qu Ning, Shi Rong-Liang, Lu Zhong-Wu, Ji Qing-Hai, Wu Wei-Li
Department of Surgical Oncology, Rui'an People's Hospital, Third Affiliated Hospital of Wenzhou Medical University, Wenzhou.
Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.
Onco Targets Ther. 2016 Aug 24;9:5307-16. doi: 10.2147/OTT.S107913. eCollection 2016.
The surgical management of papillary thyroid microcarcinoma (PTMC), especially regarding the necessity of central/lateral lymph node dissection, remains controversial. This study investigated the clinicopathologic factors predictive of lymph node metastasis (LNM) in patients diagnosed with PTMC. Multivariate logistic regression analysis was used for PTMC patients identified from the Surveillance, Epidemiology, and End Results database who were treated by surgery between 2002 and 2012, to determine the association of clinicopathologic factors with LNM. According to the results, a total of 31,017 patients met the inclusion criteria of the study. Final histology confirmed 2,135 (6.9%) cases of N1a disease and 1,684 cases (5.4%) of N1b disease. Our multivariate logistic regression analysis identified variables associated with both central LNM and lateral lymph node metastasis (LLNM), including a younger age (<45 years), male sex, non-Hispanic white and other race, classical papillary histology, larger tumor size, multifocality, and extrathyroidal extension; distant metastasis was also significantly associated with LLNM. The significant predictors identified from multivariable logistic regression were integrated into a statistical model that showed that extrathyroidal extension had maximum weight in the predictive role for LNM. LLNM was validated to be a significant risk factor for cancer-specific death in Cox regression analyses, whereas central LNM failed to predict a worse cancer-specific survival according to our data. Therefore, we suggested that central lymph node dissection could be performed in certain patients with risk factors. Given the prevalence of LLNM in PTMC, a thorough inspection of the lateral compartment is recommended in PTMC patients with risk factors for precise staging; from the viewpoint of a radical treatment for tumors, prophylactic lateral lymph node dissection that aims to remove the occult lateral lymph nodes may be an option for PTMC with risk factors. Multicenter studies with long-term follow-up are recommended to better understand the risk factors and surgical management for cervical nodes in PTMC.
甲状腺微小乳头状癌（PTMC）的手术治疗，尤其是关于中央/侧方淋巴结清扫的必要性，仍存在争议。本研究调查了诊断为PTMC的患者中预测淋巴结转移（LNM）的临床病理因素。对2002年至2012年间在监测、流行病学和最终结果数据库中识别出的接受手术治疗的PTMC患者进行多因素逻辑回归分析，以确定临床病理因素与LNM的关联。结果显示，共有31,017例患者符合研究纳入标准。最终组织学确诊2,135例（6.9%）N1a期疾病和1,684例（5.4%）N1b期疾病。我们的多因素逻辑回归分析确定了与中央LNM和侧方淋巴结转移（LLNM）均相关的变量，包括年龄较小（<45岁）、男性、非西班牙裔白人和其他种族、经典乳头状组织学、肿瘤较大、多灶性和甲状腺外侵犯；远处转移也与LLNM显著相关。从多变量逻辑回归中确定的显著预测因素被整合到一个统计模型中，该模型显示甲状腺外侵犯在LNM的预测作用中权重最大。在Cox回归分析中，LLNM被证实是癌症特异性死亡的显著危险因素，而根据我们的数据，中央LNM未能预测更差的癌症特异性生存。因此，我们建议在某些有危险因素的患者中可进行中央淋巴结清扫。鉴于PTMC中LLNM的发生率，建议对有危险因素的PTMC患者进行侧方区域的彻底检查以进行精确分期；从肿瘤根治性治疗的角度来看，旨在切除隐匿性侧方淋巴结的预防性侧方淋巴结清扫可能是有危险因素的PTMC的一种选择。建议进行长期随访的多中心研究，以更好地了解PTMC颈部淋巴结的危险因素和手术治疗。
