Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Division of Endocrinology, Metabolism, Nutrition and Diabetes, Mayo Clinic, Rochester, MN, USA.
Ann Surg Oncol. 2019 Jan;26(1):86-92. doi: 10.1245/s10434-018-6871-1. Epub 2018 Nov 8.
To Identify predictors of recurrent disease following lateral neck dissection (LND) for papillary thyroid carcinoma (PTC).
A retrospective review of patients who underwent first-time LND for PTC at our institution (2000-2015) was performed. Medical records were examined for biopsy or pathologically proven lateral neck recurrence. Differences between the groups with and without recurrence were compared. All LNDs were then classified in to two groups: "comprehensive" (CND), involving levels IIa-Vb at minimum, or "selective", labelling less extensive dissection (SND).
Four hundred nine patients underwent 467 LNDs. Surveillance data were available for 317 patients who underwent 362 LNDs (mean age 45 ± 16; range 18-88). The median follow-up was 64 ± 48 months (range 3-197). Recurrence was detected in 71 lateral necks (20%). The total number of lymph nodes was greater in the group without recurrence compared to those with recurrence (23 vs. 19, p = 0.02). Among patient demographics, radioactive iodine treatment, primary tumor characteristics and characteristics of nodal metastases, only an older patient age (mean 50 vs. 43 years) was associated with lateral neck recurrence (p < .01). CND was performed in 102 lateral necks and SND in 143 necks. There were 12 recurrences recorded in the CND group (12%) vs. 31 in the SND group (22%, p = .04). The majority of recurrences (70%) involved levels included in the original dissection.
Younger patients, more extensive dissection and a higher total number of lymph nodes removed are associated with a lower incidence of lateral neck recurrence after LND for papillary thyroid carcinoma.
确定甲状腺乳头状癌（PTC）患者行侧颈部清扫术（LND）后疾病复发的预测因素。
对我院（2000-2015 年）行首次 LND 的 PTC 患者进行回顾性研究。检查病历以确定侧颈部是否有活检或病理证实的复发。比较复发组和无复发组之间的差异。所有 LND 分为两组：“综合”（CND），至少包括 IIa-Vb 水平，或“选择性”，标记为较不广泛的解剖（SND）。
409 例患者行 467 例 LND。317 例患者（362 例 LND）的随访资料可用（平均年龄 45±16 岁；范围 18-88 岁）。中位随访时间为 64±48 个月（范围 3-197 个月）。71 例侧颈部发现复发（20%）。无复发组的淋巴结总数明显多于复发组（23 对 19，p=0.02）。在患者人口统计学、放射性碘治疗、原发肿瘤特征和淋巴结转移特征中，只有年龄较大（平均 50 对 43 岁）与侧颈部复发相关（p<.01）。102 例侧颈部行 CND，143 例行 SND。CND 组有 12 例（12%）复发，SND 组有 31 例（22%）复发（p=0.04）。大多数复发（70%）涉及原始解剖的水平。
对于接受 LND 治疗的甲状腺乳头状癌患者，年轻患者、更广泛的解剖和切除的淋巴结总数较多与侧颈部复发的发生率较低相关。
