Xu Jason J, Yu Eugene, McMullen Caitlin, Pasternak Jesse, Brierley Jim, Tsang Richard, Zhang Han, Eskander Antoine, Rotstein Lorne, Sawka Anna M, Gilbert Ralph, Irish Jonathan, Gullane Patrick, Brown Dale, de Almeida John R, Goldstein David P
Department of Otolaryngology-Head and Neck Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
J Otolaryngol Head Neck Surg. 2017 May 31;46(1):43. doi: 10.1186/s40463-017-0221-3.
Practice variability exists for the extent of neck dissection undertaken for papillary thyroid carcinoma (PTC) metastatic to the lateral neck nodes, with disagreement over routine level V dissection.
We performed a retrospective medical record review of PTC patients with lateral neck nodal metastases treated at University Health Network from 2000 to 2012. Predictive factors for regional neck recurrence, including extent of initial neck dissection, were analyzed using Cox regression.
Out of 204 neck dissections in 178 patients, 110 (54%) underwent selective and 94 (46%) had comprehensive dissection including level Vb. Mean follow-up was 6.3 years (SD). Significant predictors of regional failure were the total number of suspicious nodes on preoperative imaging (p = 0.029), largest positive node on initial neck dissection (p < 0.01), and whether patients received adjuvant radiotherapy (p = 0.028). The 5-year ipsilateral regional recurrence rate was 8 and 9% with selective and comprehensive dissection, respectively (p = 0.89).
The extent of neck dissection did not predict the probability of regional recurrence in PTC patients presenting with lateral neck metastases.
对于转移至侧颈部淋巴结的乳头状甲状腺癌（PTC）患者，颈部清扫范围存在实践差异，对于是否常规清扫Ⅴ区存在分歧。
我们对2000年至2012年在大学健康网络接受治疗的伴有侧颈部淋巴结转移的PTC患者进行了回顾性病历审查。使用Cox回归分析颈部区域复发的预测因素，包括初始颈部清扫的范围。
178例患者共进行了204次颈部清扫，其中110例（54%）进行了选择性清扫，94例（46%）进行了包括Ⅴb区的根治性清扫。平均随访时间为6.3年（标准差）。区域复发的显著预测因素为术前影像学检查中可疑淋巴结的总数（p = 0.029）、初次颈部清扫时最大的阳性淋巴结（p < 0.01）以及患者是否接受辅助放疗（p = 0.028）。选择性清扫和根治性清扫的5年同侧区域复发率分别为8%和9%（p = 0.89）。
对于出现侧颈部转移的PTC患者，颈部清扫范围并不能预测区域复发的可能性。
