高分化甲状腺癌的治疗性侧颈清扫术：预测阳性淋巴结分布及预后因素的分析
Therapeutic lateral neck dissection in well-differentiated thyroid cancer: Analysis on factors predicting distribution of positive nodes and prognosis.
作者信息
Lombardi Davide, Paderno Alberto, Giordano Davide, Barbieri Diego, Taboni Stefano, Piazza Cesare, Cappelli Carlo, Bertagna Francesco, Barbieri Verter, Piana Simonetta, Bellafiore Salvatore, Spriano Giuseppe, Mercante Giuseppe, Nicolai Piero
机构信息
Department of Otorhinolaryngology - Head and Neck Surgery, University of Brescia, Brescia, Italy.
Otolaryngology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.
出版信息
Head Neck. 2018 Feb;40(2):242-250. doi: 10.1002/hed.24936. Epub 2017 Sep 30.
BACKGROUND
Neck dissection is considered the treatment of choice in patients with lateral neck metastases from well-differentiated thyroid cancer.
METHODS
A multicenter, retrospective review of patients who underwent therapeutic lateral neck dissection for well-differentiated thyroid carcinoma was carried out.
RESULTS
The study included a total of 405 lateral neck dissections performed in 352 patients; 197 women (56%) and 155 men (44%). When considering ipsilateral neck metastases, levels IIa, IIb, III, IV, Va, Vb, and V (not otherwise specified) were involved in 42%, 6%, 73%, 67%, 11%, 31%, and 35% of cases, respectively. Five-year and 10-year overall survival (OS) were 93% and 81%, respectively. Age >55 years, pathologic T (pT)4 category, tumor diameter >4 cm, aggressive variants of well-differentiated thyroid carcinoma, endovascular invasion, and number of positive nodes >5 turned out to be the most important prognostic factors.
CONCLUSION
Neck dissection is a valid treatment option in the presence of neck metastasis from well-differentiated thyroid carcinoma. Levels IIa, III, IV, and Vb should always be removed.
背景
对于高分化甲状腺癌伴有侧颈转移的患者，颈淋巴结清扫术被认为是首选治疗方法。
方法
对因高分化甲状腺癌接受治疗性侧颈淋巴结清扫术的患者进行多中心回顾性研究。
结果
该研究共纳入352例患者的405例侧颈淋巴结清扫术；其中女性197例（56%），男性155例（44%）。在考虑同侧颈部转移时，IIa、IIb、III、IV、Va、Vb和V区（未另作说明）分别在42%、6%、73%、67%、11%、31%和35%的病例中受累。5年和10年总生存率分别为93%和81%。年龄>55岁、病理T（pT）4期、肿瘤直径>4 cm、高分化甲状腺癌的侵袭性变异型、血管内侵犯以及阳性淋巴结数目>5个是最重要的预后因素。
结论
对于高分化甲状腺癌颈部转移患者，颈淋巴结清扫术是一种有效的治疗选择。IIa、III、IV和Vb区应常规清扫。
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