Pena Israel, Clayman Gary L, Grubbs Elizabeth G, Bergeron Jeffrey M, Waguespack Steven G, Cabanillas Maria E, Dadu Ramona, Hu Mimi I, Fellman Bryan M, Li Yisheng, Gross Neil D, Lai Stephen Y, Sturgis Erich M, Zafereo Mark E
Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas.
Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas.
Head Neck. 2018 Jan;40(1):79-85. doi: 10.1002/hed.24969. Epub 2017 Oct 16.
The purpose of this retrospective analysis was to evaluate the benefits of an elective lateral neck dissection (ELND) in patients with medullary thyroid cancer (MTC) without radiographically apparent lateral neck metastases.
Patients with sporadic MTC without radiographic evidence of lateral neck metastasis who underwent definitive surgery were divided into 2 groups based on surgical approach: no ELND (the observation group) and ipsilateral or bilateral ELND (the ELND group). Primary outcomes were biochemical cure, locoregional recurrence, distant metastasis, and overall survival (OS).
Sixty-six patients met inclusion criteria: 44 patients (67%) in the observation group and 22 patients (33%) in the ELND group. Two of 44 patients (5%) in the observation group developed subsequent (ipsilateral) lateral neck disease. At last follow-up, locoregional disease control rates among the observation and ELND groups were 98% and 100% (P > .999), respectively, whereas biochemical cure rates were 82% and 85% (P > .999), respectively, and 5-year OSs were 84% and 100% (P = .156), respectively.
Patients with MTC without lateral neck metastasis have similar biochemical cure rates with observation or elective dissection of lateral neck compartments.
本回顾性分析的目的是评估选择性侧颈清扫术（ELND）对无影像学可见侧颈转移的甲状腺髓样癌（MTC）患者的益处。
将接受根治性手术且无侧颈转移影像学证据的散发性MTC患者根据手术方式分为两组：未行ELND（观察组）和同侧或双侧ELND（ELND组）。主要结局指标为生化治愈、局部区域复发、远处转移和总生存期（OS）。
66例患者符合纳入标准：观察组44例（67%），ELND组22例（33%）。观察组44例患者中有2例（5%）随后出现（同侧）侧颈疾病。在最后一次随访时，观察组和ELND组的局部区域疾病控制率分别为98%和100%（P>.999），而生化治愈率分别为82%和85%（P>.999），5年总生存率分别为84%和100%（P =.156）。
无侧颈转移的MTC患者接受观察或选择性侧颈区清扫术的生化治愈率相似。
