Meng Kexin, Luo Hua, Chen Hailong, Guo Haiwei, Xia Wenjie
Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, 158 Shangtang Road.
Department of Breast Surgery, Hangzhou Hospital of Traditional Chinese Medicine, Guang Xing Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, 453 Tiyuchang Rd.
Medicine (Baltimore). 2019 Jan;98(1):e13884. doi: 10.1097/MD.0000000000013884.
Lymph node (LN) metastases are widely considered as a vital assessment of disease progression, as well as an essential indicator for biochemical cure of medullary thyroid carcinoma (MTC). Prognostic effect of numbers of metastatic LN has not been fully studied and the optimal cut-point of LN numbers has not been established. This population-based study designed to investigate prognostic value of numbers of positive LN and determinate the prognostic factors.Data were generated from Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2013. X-tile program was applied and cut points for division of LN numbers as low-, medium- and high-risk were 0, 1 to 10, and ≥11. The relationship between numbers of metastatic LN, age, tumor size, extent of tumor, and radiotherapy on overall survival (OS) and disease-specific survival (DSS) were evaluated.A total of 1466 diagnosed primary MTC patients without metastases were eligible for analysis in current study. 945 (64%) patients were classified as no positive LNs, 327 (22%) as 1 to 10 positive LNs, 194 (14%) as ≥11 positive LNs. Patients with older age, tumor size, ≥11 positive LN were associated with unfavorable OS. Those dispensed with radiation had statistically better prognosis than the others. When stratified by age, there was a significant difference in patients ≥45 years within LN categories (log-rank P < .001). When stratified by tumor size, a significant correlation was noted between rising numbers of involved nodes and falling rates of OS in tumor measuring >2cm setting (2-4 cm setting, log-rank P = .003 and >4 cm setting, log-rank P = .014, separately). There was no statistical difference of the area under the curve (AUC) for OS and DSS prediction between LN group and N stage, suggesting the 2 LN systems had the same predictive power for OS and DSS.Numbers of metastatic LN showed prognostic power in survival analysis and remained an independent survival predictor which can be evaluated in MTC treatment decisions for optimum assessment.
淋巴结（LN）转移被广泛认为是疾病进展的重要评估指标，也是甲状腺髓样癌（MTC）生化治愈的重要指标。转移性LN数量的预后影响尚未得到充分研究，且LN数量的最佳切点尚未确定。本基于人群的研究旨在调查阳性LN数量的预后价值并确定预后因素。数据来源于1998年至2013年的监测、流行病学和最终结果（SEER）数据库。应用X-tile程序，将LN数量分为低、中、高风险的切点分别为0、1至10和≥11。评估转移性LN数量、年龄、肿瘤大小、肿瘤范围和放疗与总生存期（OS）和疾病特异性生存期（DSS）之间的关系。
本研究共纳入1466例诊断为原发性MTC且无转移的患者进行分析。945例（64%）患者被分类为无阳性LN，327例（22%）为1至10个阳性LN，194例（14%）为≥11个阳性LN。年龄较大、肿瘤较大、≥11个阳性LN的患者OS较差。接受放疗的患者预后在统计学上优于其他患者。按年龄分层时，LN类别中≥45岁的患者存在显著差异（对数秩检验P<0.001）。按肿瘤大小分层时，在肿瘤大小>2cm的情况下（2至4cm组，对数秩检验P=0.003；>4cm组，对数秩检验P=0.014），受累淋巴结数量增加与OS率下降之间存在显著相关性。LN组和N分期在OS和DSS预测方面的曲线下面积（AUC）无统计学差异，表明这两种LN系统对OS和DSS具有相同的预测能力。
转移性LN数量在生存分析中显示出预后能力，并且仍然是一个独立的生存预测指标，可在MTC治疗决策中进行评估以实现最佳评估。
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