Yuan Jiru, Li Jinghua, Chen Xiaoyi, Lin Xiaodong, Du Jialin, Zhao Gang, Chen Zhengbo, Wu Zeyu
Guangdong Academy of Medical Sciences, Guangdong General Hospital, Department of General Surgery, 106, Zhong Shan Second Road, 510080 Guangzhou, Guangdong Province, China.
Guangdong Academy of Medical Sciences, Guangdong General Hospital, Department of Pathological Medicine, 106, Zhong Shan Second Road, 510080 Guangzhou, Guangdong Province, China.
Bull Cancer. 2017 Jun;104(6):516-523. doi: 10.1016/j.bulcan.2017.03.005. Epub 2017 May 2.
The first aim of this study was to explore the risk factors that were associated with central lymph node metastasis (CLNM) in patients with clinically node-negative papillary thyroid microcarcinoma (cN PTMC) after prophylactic central neck dissection (PCND). The second aim was to evaluate the influence of PCND on migration of TNM staging and risk stratification (RS) in patients with cN PTMC.
A total of 295 cN PTMC patients who underwent thyroidectomy with PCND in the Department of General Surgery at Guangdong General Hospital between March 2014 to December 2015 were assessed retrospectively. The relations of CLNM with clinicopathologic characteristics of cN PTMC were analyzed by univariate and multivariate logistic regression. The effect of PCND on migration of TNM staging and RS was also observed.
The incidence of CLNM was 42.4% (125 of 295 cases) in patients with cN PTMC. Univariate analysis showed that age (P=0.000), ultrasonographic tumor size (P=0.009), pathologic tumor size (P=0.005), and multifocality (P=0.031) were significantly associated with the incidence of CLNM. No significant correlations were found between the presence of CLNM and other variables such as gender (P=0.399), bilaterality (P=0.118), capsular invasion (P=0.111), lymphovascular invasion (P=0.184), extent of thyroidectomy (P=0.319) and lymphadenectomy (P=0.458). Multivariate logistic regression analysis revealed that age <45 years (P=0.000) and multifocality (P=0.033) were independent predictors of CLNM in patients with cN PTMC. Because of the identification of CLNM in the implementation of PCND, 42 (14.2%) patients were upstaged, and 118 (40.0%) patients upgraded in RS.
CLNM is highly prevalent in cN PTMC. Age <45 years and multifocality are independent risk factors of CLNM in cN PTMC patients. PCND can identify CLNM, which allows more accurate TNM staging/RS and may have an important impact on postoperative treatment in cN PTMC patients.
本研究的首要目的是探讨在接受预防性中央区颈淋巴结清扫术（PCND）的临床淋巴结阴性的甲状腺微小乳头状癌（cN PTMC）患者中，与中央区淋巴结转移（CLNM）相关的危险因素。第二个目的是评估PCND对cN PTMC患者TNM分期和风险分层（RS）迁移的影响。
回顾性评估2014年3月至2015年12月期间在广东省人民医院普通外科接受甲状腺切除术并进行PCND的295例cN PTMC患者。通过单因素和多因素逻辑回归分析CLNM与cN PTMC临床病理特征之间的关系。同时观察PCND对TNM分期和RS迁移的影响。
cN PTMC患者中CLNM的发生率为42.4%（295例中的125例）。单因素分析显示，年龄（P=0.000）、超声检查肿瘤大小（P=0.009）、病理肿瘤大小（P=0.005）和多灶性（P=0.031）与CLNM的发生率显著相关。未发现CLNM的存在与其他变量之间存在显著相关性，如性别（P=0.399）、双侧性（P=0.118）、包膜侵犯（P=0.111）、脉管侵犯（P=0.184）、甲状腺切除范围（P=0.319）和淋巴结清扫范围（P=0.458）。多因素逻辑回归分析显示，年龄<45岁（P=0.000）和多灶性（P=0.033）是cN PTMC患者CLNM的独立预测因素。由于在实施PCND过程中发现了CLNM，42例（1
