Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Departments of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Ann Surg. 2019 May;269(5):966-971. doi: 10.1097/SLA.0000000000002710.
To examine risk factors for posttreatment recurrence in papillary thyroid carcinoma (PTC) patients with initial presentation of lateral neck metastasis (N1b).
N1b PTC recurs after definitive treatment.
Study subjects were 437 consecutive PTC patients who underwent total thyroidectomy and therapeutic neck dissection of central and lateral compartments and postoperative radioactive iodine ablation therapy. The patients' demographics and pathological factors, including factors related to tumors and lymph nodes (LNs), and postoperative thyroglobulin levels were reviewed. Univariate and multivariate Cox proportional hazards regression analyses were used to identify factors associated with recurrence-free survival (RFS).
During a median follow-up of 83 months (range, 32-135 months), recurrence occurred in 81 (18.1%) patients. Univariate analyses showed that male sex, tumor size, macroscopic extrathyroidal extension, perineural invasion, extranodal extension, LN involvement, LN ratio, MACIS score, and postoperative serum levels of thyroglobulin were significantly associated with RFS (P < 0.05). Multivariate analyses revealed that LN ratio (> 0.25) in the lateral compartment (adjusted hazard ratio = 2.099, 95% confidence interval = 1.278-3.448; P = 0.003), and postoperative serum levels of stimulated (>5.0 ng/mL; 3.172, 1.661-6.056, P < 0.001) and unstimulated (>0.1 ng/mL; 3.200, 1.569-6.526, P = 0.001) thyroglobulin were independent predictors of any-site RFS. Clinical and tumor factors were not independent predictors of RFS outcomes (P > 0.1).
Posttreatment recurrence is predicted by the LN ratio in the lateral compartment and postoperative serum levels of thyroglobulin in patients with metastatic PTC in the lateral neck.
研究初始表现为侧颈部转移（N1b）的甲状腺乳头状癌（PTC）患者治疗后复发的危险因素。
N1b 型 PTC 在根治性治疗后会复发。
本研究纳入了 437 例连续接受全甲状腺切除术和中央及侧区颈淋巴结清扫术以及术后放射性碘消融治疗的 PTC 患者。回顾了患者的人口统计学和病理学因素，包括与肿瘤和淋巴结（LNs）相关的因素，以及术后甲状腺球蛋白水平。采用单因素和多因素 Cox 比例风险回归分析来确定与无复发生存（RFS）相关的因素。
在中位随访 83 个月（范围，32-135 个月）期间，81 例（18.1%）患者出现复发。单因素分析显示，男性、肿瘤大小、肉眼甲状腺外侵犯、神经周围侵犯、淋巴结外侵犯、淋巴结受累、淋巴结比率、MACIS 评分和术后血清甲状腺球蛋白水平与 RFS 显著相关（P<0.05）。多因素分析显示，侧区淋巴结比率（>0.25）（调整后的危险比=2.099，95%置信区间=1.278-3.448；P=0.003）和术后刺激（>5.0ng/mL；3.172，1.661-6.056，P<0.001）和未刺激（>0.1ng/mL；3.200，1.569-6.526，P=0.001）甲状腺球蛋白水平是任何部位 RFS 的独立预测因素。临床和肿瘤因素不是 RFS 结局的独立预测因素（P>0.1）。
侧颈部转移性 PTC 患者的侧区淋巴结比率和术后甲状腺球蛋白水平可预测治疗后复发。
