淋巴结比率可预测儿童乳头状甲状腺癌的复发情况。
Lymph node ratio predicts recurrence in pediatric papillary thyroid cancer.
作者信息
Rubinstein Jill C, Dinauer Catherine, Herrick-Reynolds Kayleigh, Morotti Raffaella, Callender Glenda G, Christison-Lagay Emily R
机构信息
Yale School of Medicine, Department of Surgery, New Haven, CT 06520.
Yale School of Medicine, Department of Pathology, New Haven, CT 06520.
出版信息
J Pediatr Surg. 2019 Jan;54(1):129-132. doi: 10.1016/j.jpedsurg.2018.10.010. Epub 2018 Oct 5.
BACKGROUND
Regional lymph node (LN) metastasis at the time of presentation plays a significant role in predicting recurrence in patients with papillary thyroid cancer (PTC). Multiple studies in the adult population have demonstrated that the lymph node ratio (LNR) in both the central and lateral neck can improve the accuracy of recurrence prediction, but this ratio has not been studied in the pediatric population. In this study, we sought to investigate the LNR in the central and lateral compartments as a prognostic predictor for recurrence in pediatric patients with PTC.
METHODS
A retrospective analysis of pediatric patients (≤21 years old) at a single institution between 2002 and 2014 who underwent total thyroidectomy with prophylactic central neck dissection (TTpCND) with at least 3 sampled nodes or total thyroidectomy with unilateral modified radical neck dissection (TTMRND) with at least 10 sampled nodes, and on whom at least 24 months of follow up data were available was performed. The LNR was defined as the ratio of metastatic LNs to total number of investigated LNs. Recurrence after TTpCND and TTMRND was examined separately as a function of LNR, using the value of 0.45 as a cutoff.
RESULTS
Forty-eight patients met inclusion criteria. Thirty-two underwent TTpCND, and sixteen underwent TTMRND. Median age at time of operation was 17 years (range 6-20), and median duration of follow-up was 53.5 months (range 24-183). In the TTpCND, LNR ranged from 0 to 1.0. There were two recurrences among the eight patients (25%) undergoing TTpCND in patients with LNRs >0.45 and a single recurrence among the 24 patients (4.2%) undergoing TTpCND with an LNR ≤0.45. In the TTMRND, LNR ranged from 0.1 to 1.0. There were 3 recurrences in 12 patients with LNR ≤0.45 (30.8%%) and 4 recurrences in 4 patients with LNR >0.45 (100%) (p = 0.03).
CONCLUSIONS
Although limited by small sample size, LNR may be a useful predictor to stratify the likelihood of recurrence in pediatric patients undergoing TTpCND or TTMRND for pathologic N1a or N1b PTC.
TYPE OF STUDY
Prognosis study / retrospective case series.
LEVEL OF EVIDENCE
Level IV.
背景
就诊时区域淋巴结（LN）转移在预测乳头状甲状腺癌（PTC）患者复发方面起着重要作用。针对成年人群的多项研究表明，颈部中央和侧方的淋巴结比值（LNR）可提高复发预测的准确性，但该比值在儿科人群中尚未得到研究。在本研究中，我们试图探讨中央和侧方分区的LNR作为儿科PTC患者复发的预后预测指标。
方法
对2002年至2014年间在单一机构接受全甲状腺切除术加预防性中央区颈淋巴结清扫术（TTpCND）且至少有3个取样淋巴结的儿科患者（≤21岁），或接受全甲状腺切除术加单侧改良根治性颈淋巴结清扫术（TTMRND）且至少有10个取样淋巴结的患者进行回顾性分析，这些患者至少有24个月的随访数据。LNR定义为转移淋巴结数与所研究淋巴结总数的比值。分别以0.45为临界值，将TTpCND和TTMRND后的复发情况作为LNR的函数进行研究。
结果
48例患者符合纳入标准。32例行TTpCND，16例行TTMRND。手术时的中位年龄为17岁（范围6 - 20岁），中位随访时间为53.5个月（范围24 - 183个月）。在TTpCND中，LNR范围为0至1.0。LNR>0.45的8例接受TTpCND的患者中有2例复发（25%），LNR≤0.45的24例接受TTpCND的患者中有1例复发（4.2%）。在TTMRND中，LNR范围为0.1至1.0。LNR≤0.45的12例患者中有3例复发（30.8%），LNR>0.45的4例患者中有4例复发（100%）（p = 0.03）。
结论
尽管受样本量小的限制，LNR可能是对因病理N1a或N1b PTC接受TTpCND或TTMRND的儿科患者复发可能性进行分层的有用预测指标。
研究类型
预后研究/回顾性病例系列。
证据级别
四级。
Zotero 插件