Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Garibaldi-Nesima Medical Center, Via Palermo 636, 95122, Catania, Italy.
Infectious Disease, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
J Endocrinol Invest. 2017 Dec;40(12):1355-1363. doi: 10.1007/s40618-017-0714-y. Epub 2017 Jun 23.
Papillary thyroid carcinoma (PTC), the most common thyroid cancer histotype, has a good prognosis even when spread to the neck lymph node (LN). The prognostic role of LN metastases' location is still controversial. The aim of the present study was to evaluate the clinical relevance of the number and location of LN metastases at presentation in PTCs.
This retrospective study included a consecutive series of 1653 PTC patients followed for a mean period of 5.9 years in a referral thyroid cancer clinic. All patients have undergone thyroidectomy with the dissection of at least six LNs. According to the LN status, patients were subdivided into 569 N0 (34.4%), 644 N1a (39.0%, central compartment) and 440 N1b (26.6%, latero-cervical compartment).
Age at diagnosis was significantly lower in N1b (39.8, IQR 30.7-51.6) and N1a (40.1, IQR 31.3-50.1) than in N0 (44.7, IQR 36.6-55.0 yrs). The male gender was more prevalent in N1b than in N1a and N0 (F/M = 1.9/1, 4.0/1 and 5.5/1, respectively). Persistent/recurrent disease at last control was significantly more frequent in N1b (29.8%) than in N1a (14.3%), and in N1a than in N0 (4.2%) (p < 0.01 for all). Also, distant metastases were significantly (p < 0.001) more frequent in N1b (14.1%) than in N1a (4.3%) and N0 (1.6%). LN metastases' number (>5) was a significant risk factor for persistent/recurrent disease only for N1a patients.
These data indicate that persistent/recurrent disease and distant metastases are significantly more frequent in patients with latero-cervical LN (N1b) metastases and that the LN location should be used for a better postsurgical risk stratification.
甲状腺乳头状癌（PTC）是最常见的甲状腺癌组织学类型，即使转移到颈部淋巴结（LN），其预后也较好。LN 转移部位的预后作用仍存在争议。本研究旨在评估 PTC 患者就诊时 LN 转移数量和位置的临床相关性。
本回顾性研究纳入了在甲状腺癌诊所连续就诊的 1653 例 PTC 患者，平均随访时间为 5.9 年。所有患者均接受甲状腺切除术，并至少清扫 6 枚 LN。根据 LN 状态，患者分为 569 例 N0（34.4%，中央区）、644 例 N1a（39.0%，中央区）和 440 例 N1b（26.6%，颈侧区）。
N1b（39.8，IQR 30.7-51.6）和 N1a（40.1，IQR 31.3-50.1）患者的诊断年龄明显低于 N0（44.7，IQR 36.6-55.0 岁）。N1b 患者的男性比例明显高于 N1a 和 N0（男女比分别为 1.9/1、4.0/1 和 5.5/1）。N1b 患者持续性/复发性疾病的比例（29.8%）明显高于 N1a（14.3%）和 N0（4.2%）（均 P<0.01）。此外，N1b 患者远处转移的比例（14.1%）明显高于 N1a（4.3%）和 N0（1.6%）（均 P<0.001）。仅 N1a 患者的 LN 转移数量（>5 枚）是持续性/复发性疾病的显著危险因素。
这些数据表明，颈侧区 LN（N1b）转移患者持续性/复发性疾病和远处转移的比例明显更高，LN 位置应用于更好的术后风险分层。
