Sun Yungang, Liu Xiang, Ouyang Wei, Feng Huijuan, Wu Juqing, Chen Pan, Wang Jing
Deparment of Nuclear Medicine, Zhujiang Hospital of Southern Medical University, 253 Gongye Road, Guangzhou, Guangdong Province, China.
Department of Pharmaceutical Sciences, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong Province, China.
Oral Oncol. 2017 Mar;66:22-27. doi: 10.1016/j.oraloncology.2016.12.028. Epub 2017 Jan 6.
To determine lymph node (LN) characteristics predictive of locoregional recurrence (LRR) in adolescent and young adult (AYA) ages 15-39years presenting with papillary thyroid cancer (PTC) and cervical pathologically proven LN metastases (pN1).
Retrospective chart review was performed for all patients with PTC and nodal metastases who had undergone total thyroidectomy, LN dissection, and postoperative radioactive iodine therapy in a university hospital between 2006 and 2014. Clinical and histopathologic markers that were independently associated with tumor recurrence were evaluated.
In all, 329 consecutive AYA patients were included. At a median follow-up of 57months, twenty patients (6.08%) experienced LRR. No patients had distant metastases, and no patients died during follow-up. Based on Cox regression analysis, the presence of extranodal extension and more than six metastatic LNs at presentation were independent predictive factors for LRR. However, age, male sex, total number of LNs resected, pN1b, LN ratio, size of the largest metastatic LN, extrathyroidal extension, tumor size, bilateral tumor, multifocality, vascular invasion, and Hashimoto thyroiditis were not correlated with an increased risk for LRR. A cutoff of more than six positive nodes optimally predicted future LRR with sensitivity and specificity values of 85.0% and 60.2%, respectively.
The presence of extranodal extension and more than six metastatic LNs were independent predictors of LRR in AYA patients with pN1 disease. Evaluation of these prognostic factors appears to help identify patients who require close monitoring.
确定15至39岁患有乳头状甲状腺癌（PTC）且经病理证实有颈部淋巴结转移（pN1）的青少年及青年成人（AYA）患者中，预测局部区域复发（LRR）的淋巴结（LN）特征。
对2006年至2014年间在某大学医院接受全甲状腺切除术、淋巴结清扫术及术后放射性碘治疗的所有PTC伴淋巴结转移患者进行回顾性病历审查。评估与肿瘤复发独立相关的临床和组织病理学标志物。
共纳入329例连续的AYA患者。中位随访57个月时，20例患者（6.08%）出现LRR。无患者发生远处转移，且随访期间无患者死亡。基于Cox回归分析，出现结外扩展及就诊时转移淋巴结超过6个是LRR的独立预测因素。然而，年龄、男性、切除的淋巴结总数、pN1b、淋巴结比率、最大转移淋巴结大小、甲状腺外扩展、肿瘤大小、双侧肿瘤、多灶性、血管侵犯及桥本甲状腺炎与LRR风险增加无关。阳性淋巴结超过6个的临界值对未来LRR的预测最佳，敏感性和特异性分别为85.0%和60.2%。
结外扩展及超过6个转移淋巴结的存在是pN1疾病AYA患者LRR的独立预测因素。对这些预后因素的评估似乎有助于识别需要密切监测的患者。
