Liu Zheng, Lei Jianyong, Liu Yang, Fan Yuxia, Wang Xiaoming, Lu Xiubo
Thyroid Surgery, The First Affiliated Hospital of Zhengzhou University, Zheng Zhou Thyroid and Parathyroid Center, West China Hospital of Sichuan University, Chengdu, China.
Medicine (Baltimore). 2017 Mar;96(10):e6240. doi: 10.1097/MD.0000000000006240.
Lateral lymph node metastasis (LNM) is not uncommon in papillary thyroid microcarcinoma (PTMC). Our present study aimed to investigate the risk factors associated with lateral LNM in PTMC.We retrospectively collected data pertaining to 366 patients with PTMC who underwent surgery at our center from 2010 to 2015. These patients were divided into the following 2 groups: a lateral LNM-positive group and a lateral LNM-negative group. Clinical and ultrasound data were compared between the 2 groups to determine the risk factors associated with lateral LNM.Univariate and multivariate analyses indicated that capsule invasion (OR = 3.995, 95% CI, 2.148-7.430) and upper portion location (OR = 4.541, 95% CI, 2.444-8.438) were significant risk factors for lateral LNM of PTMC and that capsule invasion (AUC = 0.666) and upper portion location (AUC = 0.678) could be used to predict lateral LNM of PTMC. Moreover, the patients in lateral LNM positive group exhibited significantly higher rates of tumor recurrence or metastasis than the patients in lateral LNM negative group (P = 0.027).Patients with PTMC located in the upper portion or exhibiting capsule invasion should receive meticulous preoperative evaluations for lateral LNM, prophylactic lateral LND may be considered.
侧方淋巴结转移(LNM)在甲状腺微小乳头状癌(PTMC)中并不少见。我们目前的研究旨在探讨PTMC侧方LNM的相关危险因素。我们回顾性收集了2010年至2015年在我们中心接受手术的366例PTMC患者的数据。这些患者被分为以下两组:侧方LNM阳性组和侧方LNM阴性组。比较两组的临床和超声数据,以确定与侧方LNM相关的危险因素。单因素和多因素分析表明,包膜侵犯(OR = 3.995,95%CI,2.148 - 7.430)和上部位置(OR = 4.541,95%CI,2.444 - 8.438)是PTMC侧方LNM的显著危险因素,并且包膜侵犯(AUC = 0.666)和上部位置(AUC = 0.678)可用于预测PTMC的侧方LNM。此外,侧方LNM阳性组患者的肿瘤复发或转移率显著高于侧方LNM阴性组患者(P = 0.027)。位于上部或有包膜侵犯的PTMC患者应接受细致的术前侧方LNM评估,可考虑预防性侧方淋巴结清扫术。