Ma N, Li J R, Guo H G
Department of Otolaryngology Head and Neck Surgery, Navy General Hospital, Center of Otolaryngology of PLA, Beijing, 100048, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2016 Apr 20;30(8):641-644. doi: 10.13201/j.issn.1001-1781.2016.08.015.
To study the risk factors related to level Ⅵ lymph node metastasis in clinical N0 (cN0) papillary thyroid carcinoma (PTC). A total of 107 cases with cN0 PTC treated in the same group were analyzed retrospectively. The frequency and risk factors for level Ⅵ lymph node metastasis in these patients were analyzed. Level Ⅵ lymph node metastasis existed in 51.40% (55/107) cases. In univariate analysis, level Ⅵ lymph node metastasis was associated with age (χ²=9.090,<0.01), gender (χ²=5.061,<0.05), tumor maximum diameter (χ²=8.772,<0.01), tumor multifocality (χ²=8.120,<0.01), capsular invasion (χ²=4.960,<0.05), and surrounding tissue invasion (χ²=3.858,<0.05), but not with nodular goiter or Hashimoto's thyroiditis. Multivariate logistic analysis indicated that age,tumor maximum diameter, multifocal tumors and surrounding tissue invasion were independent risk factors for level Ⅵ lymph node metastasis. A high risk level Ⅵ lymph node metastasis exists in DTC with clinical N0. Prophylactic level Ⅵ neck dissection is strongly recommended in patients with PTC who are younger, tumor size more than 2 cm, multifocal tumor and surrounding tissue invasion.
研究临床N0(cN0)期甲状腺乳头状癌(PTC)中与Ⅵ区淋巴结转移相关的危险因素。回顾性分析同一组中接受治疗的107例cN0期PTC患者。分析这些患者Ⅵ区淋巴结转移的发生率及危险因素。107例患者中Ⅵ区淋巴结转移发生率为51.40%(55/107)。单因素分析显示,Ⅵ区淋巴结转移与年龄(χ²=9.090,P<0.01)、性别(χ²=5.061,P<0.05)、肿瘤最大径(χ²=8.772,P<0.01)、肿瘤多灶性(χ²=8.120,P<0.01)、包膜侵犯(χ²=4.960,P<0.05)及周围组织侵犯(χ²=3.858,P<0.05)有关,而与结节性甲状腺肿或桥本甲状腺炎无关。多因素logistic分析表明,年龄、肿瘤最大径、多灶性肿瘤及周围组织侵犯是Ⅵ区淋巴结转移的独立危险因素。临床N0期分化型甲状腺癌存在较高的Ⅵ区淋巴结转移风险。对于年龄较小、肿瘤大小超过2 cm、多灶性肿瘤及周围组织侵犯的PTC患者,强烈建议行预防性Ⅵ区颈淋巴结清扫术。