Department of General Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Pathology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Int J Surg. 2018 Nov;59:90-98. doi: 10.1016/j.ijsu.2018.09.004. Epub 2018 Oct 17.
Central lymph node metastasis(CLNM) is common in papillary thyroid carcinoma(PTC). LNM is related to local recurrence and adverse prognosis. The extent of prophylactic central lymph node dissection(pCLND) is not well defined. We aim to investigate the prevalence and risk factors for contralateral central lymph node metastasis (CCLNM) in unilateral clinical node-negative (cN0) PTC patients to determine the appropriate extent of pCLND.
A systematic literature search was performed using PubMed and Embase databases until May 2018. Published studies that estimated the association between clinicopathologic factors and CCLNM were included.
A total of 6 studies involving 1399 patients were included. The prevalence of CCLNM was 10.9% in all patients. The pooled analysis revealed that male gender (pooled OR = 1.67, 95%CI = 1.11-2.53, p = 0.015), age<45years (pooled OR = 1.97, 95%CI = 1.37-2.85, p < 0.001), lymphovasular invasion (pooled OR = 4.23, 95%CI = 2.25-7.98, p < 0.001), extrathyroid invasion (pooled OR = 1.75, 95%CI = 1.08-2.83, p = 0.023), and ipsilateral CLNM (pooled OR = 12.26, 95%CI = 7.27-20.67, p < 0.001) were significant risk factors for CCLNM. While tumor size>1 cm (pooled OR = 3.39, 95%CI = 0.83-13.88, P = 0.090), capsular invasion (pooled OR = 1.28, 95%CI = 0.79-2.06, p = 0.313), extrathyroid extension (pooled OR = 1.49, 95%CI = 0.86-2.56, p = 0.152), and MACIS≥6 (pooled OR = 1.08, 95%CI = 0.51-2.26, p = 0.844) were not significantly associated with CCLNM.
Our meta-analysis identified that male gender, age<45years, lymphovasular invasion, extrathyroid invasion and ipsilateral CLNM were significant risk factors for CCLNM. These findings may guide the extent of pCLND in unilateral cN0 PTC patients.
中央淋巴结转移（CLNM）在甲状腺乳头状癌（PTC）中很常见。LNM 与局部复发和不良预后有关。预防性中央淋巴结清扫术（pCLND）的范围尚未明确。我们旨在研究单侧临床淋巴结阴性（cN0）PTC 患者对侧中央淋巴结转移（CCLNM）的发生率和危险因素，以确定适当的 pCLND 范围。
使用 PubMed 和 Embase 数据库进行系统文献检索，直到 2018 年 5 月。纳入了估计临床病理因素与 CCLNM 之间关联的已发表研究。
共有 6 项研究纳入了 1399 名患者。所有患者中 CCLNM 的发生率为 10.9%。汇总分析显示，男性（汇总 OR=1.67，95%CI=1.11-2.53，p=0.015）、年龄<45 岁（汇总 OR=1.97，95%CI=1.37-2.85，p<0.001）、血管侵犯（汇总 OR=4.23，95%CI=2.25-7.98，p<0.001）、甲状腺外侵犯（汇总 OR=1.75，95%CI=1.08-2.83，p=0.023）和同侧 CLNM（汇总 OR=12.26，95%CI=7.27-20.67，p<0.001）是 CCLNM 的显著危险因素。而肿瘤直径>1cm（汇总 OR=3.39，95%CI=0.83-13.88，P=0.090）、包膜侵犯（汇总 OR=1.28，95%CI=0.79-2.06，p=0.313）、甲状腺外延伸（汇总 OR=1.49，95%CI=0.86-2.56，p=0.152）和 MACIS≥6（汇总 OR=1.08，95%CI=0.51-2.26，p=0.844）与 CCLNM 无显著相关性。
我们的荟萃分析确定男性、年龄<45 岁、血管侵犯、甲状腺外侵犯和同侧 CLNM 是 CCLNM 的显著危险因素。这些发现可能指导单侧 cN0 PTC 患者 pCLND 的范围。
