Hong Young Ran, Lee So Hee, Lim Dong Jun, Kim Min Hee, Jung Chan Kwon, Chae Byung Joo, Song Byung Joo, Bae Ja Seong
Department of Surgery, CHA Bundang Medical Center, CHA University, Gyeonggi-do, Korea.
Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
World J Surg Oncol. 2017 Apr 4;15(1):74. doi: 10.1186/s12957-017-1141-4.
The aims of this study were to identify the clinical significances of the size of metastatic lymph node (mLN) and LN ratio (LNR) and to attempt to create a risk stratification for papillary thyroid carcinoma (PTC) patients.
We investigated the 435 PTC patients who underwent radioactive iodine (RAI) ablation treatment following thyroid surgery. The patients were classified into two groups (micrometastasis (pN1mic) ≤ 0.2 cm and macrometastasis (pN1mac) > 0.2 cm) and were stratified into the following three risk groups: group I (pN1mic, LNR ≤ 0.5); group II (pN1mic, LNR > 0.5 or pN1mac, LNR ≤ 0.5); and group III (pN1mac with LNR > 0.5). And then we investigated the association of the classified groups and variable clinicopathologic factors.
The clinical characteristics such as large tumor size, extrathyroidal extension, higher T stage, and greater number of mLN or LNR were significantly associated with pN1mac. The mean stimulated thyroglobulin levels were increased with the patient risk groups (p = 0.02). The recurrence-free survivals were significantly different between the stratified groups (p = 0.001).
The patient groups I, II, and III may be referred to as low-, intermediate-, and high-risk groups. Clinicians should consider the possibility of recurrence, and the decisions about the application of RAI ablation based on the size of mLN and the patient's risk groups.
本研究的目的是确定转移性淋巴结（mLN）大小和淋巴结比率（LNR）的临床意义，并尝试为甲状腺乳头状癌（PTC）患者创建风险分层。
我们调查了435例甲状腺手术后接受放射性碘（RAI）消融治疗的PTC患者。患者被分为两组（微转移（pN1mic）≤0.2 cm和宏转移（pN1mac）>0.2 cm），并分层为以下三个风险组：I组（pN1mic，LNR≤0.5）；II组（pN1mic，LNR>0.5或pN1mac，LNR≤0.5）；和III组（pN1mac且LNR>0.5）。然后我们研究了分类组与各种临床病理因素之间的关联。
大肿瘤大小、甲状腺外侵犯、更高的T分期以及更多的mLN或LNR等临床特征与pN1mac显著相关。平均刺激甲状腺球蛋白水平随患者风险组增加（p = 0.02）。分层组之间的无复发生存率有显著差异（p = 0.001）。
I、II和III组患者可分别称为低、中、高风险组。临床医生应考虑复发的可能性，并根据mLN大小和患者风险组来决定是否应用RAI消融。
