Yuan Jiru, Li Jinghua, Chen Xiaoyi, Zhong Zhenwei, Chen Zhengbo, Yin Ying, Du Jialin, Cong Shuzhen, Wu Zeyu
Department of General Surgery Department of Pathological Medicine Department of Ultrasound, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.
Medicine (Baltimore). 2017 Sep;96(35):e7908. doi: 10.1097/MD.0000000000007908.
The aim of this study was to identify the risk factors associated with lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) metastasis in patients with papillary thyroid carcinoma (PTC).A total of 81 PTC patients who underwent total/near-total thyroidectomy with LN-prRLN dissection in the Department of General Surgery at Guangdong General Hospital between June 2015 and August 2016 were assessed retrospectively. The relations of LN-prRLN metastasis with clinicopathologic characteristics of PTC were analyzed by univariate and multivariate logistic regression.The incidence of LN-prRLN metastasis in patients with PTC was 51.9% (42 of 81 cases). Univariate analysis showed that lateral LN metastasis (P = .005), VIa central LN metastasis (P = .000), pathologic tumor size (P = .000), capsular invasion (P = .002), and extrathyroidal invasion (P = .018) (P < .05) were significantly associated with the increased incidence of LN-prRLN metastasis in PTC. No significant correlations were found between LN-prRLN metastasis and other variables such as gender (P = .056), age (P = .448), clinical N stage (cN) (P = .063), tumor location (P = .336), tumor site (P = .909), right tumor existence (P = .793), and multifocality (P = .381). Multivariate logistic regression analysis revealed that VIa central LN metastasis (OR: 4.490, P = .027) was independent risk factors of LN-prRLN metastasis in patients with PTC.LN-prRLN metastasis is often indentified in patients with PTC. VIa central LN metastasis is an independent predictors of LN-prRLN metastasis, which allow for selective LN-prRLN dissection in patients with PTC.
本研究旨在确定与甲状腺乳头状癌（PTC）患者右侧喉返神经后方淋巴结（LN-prRLN）转移相关的危险因素。回顾性评估了2015年6月至2016年8月在广东省人民医院普通外科接受全甲状腺/近全甲状腺切除及LN-prRLN清扫术的81例PTC患者。通过单因素和多因素逻辑回归分析LN-prRLN转移与PTC临床病理特征的关系。PTC患者中LN-prRLN转移的发生率为51.9%（81例中的42例）。单因素分析显示，侧方淋巴结转移（P = 0.005）、Ⅵa区中央淋巴结转移（P = 0.000）、病理肿瘤大小（P = 0.000）、包膜侵犯（P = 0.002）和甲状腺外侵犯（P = 0.018）（P < 0.05）与PTC患者LN-prRLN转移发生率增加显著相关。未发现LN-prRLN转移与其他变量如性别（P = 0.056）、年龄（P = 0.448）、临床N分期（cN）（P = 0.063）、肿瘤位置（P = 0.336）、肿瘤部位（P = 0.909）、右侧肿瘤存在情况（P = 0.793）和多灶性（P = 0.381）之间存在显著相关性。多因素逻辑回归分析显示，Ⅵa区中央淋巴结转移（OR：4.490，P = 0.027）是PTC患者LN-prRLN转移的独立危险因素。PTC患者中常发现LN-prRLN转移。Ⅵa区中央淋巴结转移是LN-prRLN转移的独立预测因素，这使得PTC患者可进行选择性LN-prRLN清扫术。
