Genpeng Li, Jianyong Lei, Jiaying You, Ke Jiang, Zhihui Li, Rixiang Gong, Lihan Zhang, Jingqiang Zhu
Thyroid and Parathyroid Surgery Center, West China Hospital West China School of Medicine, Sichuan University, Sichuan, Chengdu, China.
Medicine (Baltimore). 2018 Feb;97(5):e9619. doi: 10.1097/MD.0000000000009619.
The multifocal papillary thyroid cancer (PTC), with more aggressive and poorer prognosis, is not rare in papillary histotype. Few studies evaluated risk factors and lymph node metastasis in multifocal PTC. The aim of this present study focusing on risk factors and lymph node metastasis characteristics in multifocal PTC was excepted to assist clinical decisions regarding surgery.It was a retrospective study. The 1249 consecutive patients with PTC were reviewed. Of these, 570 patients who met the criteria were selected: 285 with solitary papillary thyroid cancer and 285 with multifocal PTC. The risk factors and lymph node metastasis in multifocal PTC were investigated by univariate and multivariate analysis.Multifocal PTC showed a higher positive rate of capsular invasion, extrathyroidal extension, tumor size >10 mm, pathological T classification, N+ stage, local recurrence, and radioactive iodine ablation (RAI). Capsular invasion (hazard ratio [HR], 1.589; 95% confidence interval [CI],1.352-1.984), advanced pathological T classification (HR, 3.582; 95% CI, 2.184-5.870), and pathological N+ stage (HR, 1.872; 95% CI, 1.278-2.742) were related to increased risk of multifocality and there was a significant increased HR for central neck compartment involvement in male sex (HR, 2.694; 95% CI, 1.740-4.169), advanced pathological T classification (HR, 2.403; 95% CI, 1.479-3.907) and multifocality (HR, 1.988; 95% CI, 1.361-2.906).There is a significant association between capsular invasion, advanced pathological T classification, N+ stage, and multifocal PTC. Total thyroidectomy plus prophylactic bilateral central lymph node dissection should be recommended during surgery due to a stronger predilection for level VI lymph node metastasis in multifocal PTC.
多灶性乳头状甲状腺癌（PTC）在乳头状组织学类型中并不罕见，其侵袭性更强且预后较差。很少有研究评估多灶性PTC的危险因素和淋巴结转移情况。本研究旨在关注多灶性PTC的危险因素和淋巴结转移特征，以期为手术相关的临床决策提供帮助。这是一项回顾性研究。对1249例连续性PTC患者进行了回顾。其中，选取了570例符合标准的患者：285例为单灶性乳头状甲状腺癌，285例为多灶性PTC。通过单因素和多因素分析研究多灶性PTC的危险因素和淋巴结转移情况。多灶性PTC表现出更高的包膜侵犯、甲状腺外侵犯、肿瘤大小>10mm、病理T分级、N+分期、局部复发及放射性碘消融（RAI）阳性率。包膜侵犯（风险比[HR]，1.589；95%置信区间[CI]，1.352 - 1.984）、高级别病理T分级（HR，3.582；95%CI，2.184 - 5.870）和病理N+分期（HR，1.872；95%CI，1.278 - 2.742）与多灶性风险增加相关，男性中央颈部区域受累的HR显著增加（HR，2.694；95%CI，1.740 - 4.169），高级别病理T分级（HR，2.403；95%CI，1.479 - 3.907）和多灶性（HR，1.988；95%CI，1.361 - 2.906）。包膜侵犯、高级别病理T分级、N+分期与多灶性PTC之间存在显著关联。由于多灶性PTC对Ⅵ区淋巴结转移有更强的偏好，手术期间应推荐行全甲状腺切除术加双侧中央区预防性淋巴结清扫术。
