Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Centre, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 135-710, South Korea.
Br J Surg. 2017 Jun;104(7):857-867. doi: 10.1002/bjs.10514. Epub 2017 Mar 15.
The patterns, predictive factors and prognostic impact of multilevel metastasis in patients with N1b papillary thyroid carcinoma (PTC) were investigated.
A retrospective review of patients with N1b PTC from a tertiary referral centre in Korea who underwent unilateral modified radical neck dissection was undertaken.
Of 658 patients, multilevel metastasis was found in 73·9 per cent; the most common type was metastasis in two levels. Tumour size per 0·1-cm increment (adjusted odds ratio (OR) 1·33, 95 per cent c.i. 1·08 to 1·64), microscopic extrathyroidal extension (adjusted OR 1·72, 1·10 to 2·71), gross extrathyroidal extension (adjusted OR 2·35, 1·24 to 4·46), unilateral central lymph node metastasis (adjusted OR 2·45, 1·53 to 3·92) and bilateral central lymph node metastasis (adjusted OR 4·06, 2·29 to 7·18) were independent predictors of multilevel metastasis. Only four-level metastasis significantly increased the risk of overall locoregional recurrence (LRR) (adjusted hazard ratio (HR) 7·41, 95 per cent c.i. 2·20 to 24·53) and lateral neck LRR (adjusted HR 7·22, 1·82 to 28·65), compared with one-level metastasis. Two subgroup analyses were conducted, showing that only three-level metastasis including metastasis in level V significantly increased the risk of overall LRR (adjusted HR 5·66, 1·20 to 26·75). In addition, having level V metastasis was an independent predictor of both overall (adjusted HR 3·26, 1·72 to 6·18; P < 0·001) and lateral neck (adjusted HR 3·28, 1·50 to 7·16; P = 0·003) LRR.
Level V metastasis rather than multilevel metastasis itself is associated with an increased risk of LRR. Patients with N1b PTC and level V metastasis require risk restratification and meticulous follow-up.
本研究旨在探讨 N1b 期甲状腺乳头状癌（PTC）患者多水平转移的模式、预测因素和预后影响。
回顾性分析了韩国一家三级转诊中心接受单侧改良根治性颈淋巴结清扫术的 N1b 期 PTC 患者。
658 例患者中，73.9%存在多水平转移，最常见的转移类型为 2 个水平的转移。肿瘤大小每增加 0.1cm（调整后的优势比（OR）1.33，95%置信区间（CI）1.08 至 1.64）、显微镜下甲状腺外侵犯（调整后的 OR 1.72，1.10 至 2.71）、大体甲状腺外侵犯（调整后的 OR 2.35，1.24 至 4.46）、单侧中央淋巴结转移（调整后的 OR 2.45，1.53 至 3.92）和双侧中央淋巴结转移（调整后的 OR 4.06，2.29 至 7.18）是多水平转移的独立预测因素。只有 4 个水平的转移显著增加了总局部区域复发（LRR）（调整后的风险比（HR）7.41，95%CI 2.20 至 24.53）和侧颈 LRR（调整后的 HR 7.22，1.82 至 28.65）的风险，与 1 个水平的转移相比。进行了两项亚组分析，结果显示，只有包括 V 水平转移的 3 个水平转移显著增加了总 LRR 的风险（调整后的 HR 5.66，1.20 至 26.75）。此外，V 水平转移是总（调整后的 HR 3.26，1.72 至 6.18；P<0.001）和侧颈（调整后的 HR 3.28，1.50 至 7.16；P=0.003）LRR 的独立预测因素。
V 水平的转移而不是多水平转移本身与 LRR 风险增加相关。N1b 期 PTC 合并 V 水平转移的患者需要进行风险分层和仔细的随访。
