Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Surgery. 2019 Jul;166(1):55-60. doi: 10.1016/j.surg.2019.01.025. Epub 2019 Mar 12.
BACKGROUND: Lymph node metastases from papillary thyroid cancer is believed to disseminate sequentially, first to the central neck and later to the lateral neck. Skip metastases of papillary thyroid cancer, however, are defined as lateral lymph node metastasis without central lymph node metastasis. The aim of this study was to investigate the risk factors for skip metastases and lateral lymph node metastasis of papillary thyroid cancer. METHODS: We reviewed 721 papillary thyroid cancer patients undergoing total thyroidectomy with central lymph node dissection and lateral lymph node dissection during 2013 to 2018. Multivariate logistic regression analysis was performed to identify clinicopathologic risk factors for skip metastasis and lateral lymph node metastasis of papillary thyroid cancer. RESULTS: The rate of skip metastases was 7.4% (42 of 567 patients). Multivariate analysis showed that female sex and papillary thyroid microcarcinoma (≤ 1 cm) were independent risk factors for skip metastases, with odds ratios ([OR], 95% confidence interval [CI]) of 2.29 (1.02-5.16) and 2.84 (1.46-5.16), respectively. Intrathyroidal spread of papillary thyroid cancer and an increased number of central lymph nodes dissected were inversely associated with skip metastases with ORs (95% CI) of 0.13 (0.02-0.99) and 0.88 (0.83-0.94), respectively. In contrast, a greater tumor size, central lymph node metastasis, an increased number of central lymph nodes dissected, and an increased number of lateral lymph nodes dissected were associated with a lateral lymph node metastasis risk of papillary thyroid cancer, with ORs (95% CI) as follow: 1.67 (1.08-2.59), 3.07 (1.71-5.52), 1.25 (1.14-1.37), and 1.07 (1.04-1.10), respectively, by multivariate analysis. CONCLUSION: Greater tumor size, central lymph node metastasis, and an increased number of both central lymph nodes and lateral lymph nodes dissected were predictors for lateral lymph node metastasis of papillary thyroid cancer. In addition, papillary thyroid microcarcinoma was an independent risk factor for skip metastases. A complete and comprehensive central compartment dissection may decrease the false-positive detection of skip metastases of papillary thyroid cancer.
背景：甲状腺乳头状癌的淋巴结转移被认为是依次发生的，首先转移到中央颈部，然后转移到侧颈部。然而，甲状腺乳头状癌的跳跃性转移被定义为没有中央淋巴结转移的侧方淋巴结转移。本研究旨在探讨甲状腺乳头状癌跳跃性转移和侧方淋巴结转移的危险因素。
方法：我们回顾了 2013 年至 2018 年间 721 例接受全甲状腺切除术和中央淋巴结清扫术及侧方淋巴结清扫术的甲状腺乳头状癌患者。采用多变量 logistic 回归分析确定甲状腺乳头状癌跳跃性转移和侧方淋巴结转移的临床病理危险因素。
结果：跳跃性转移率为 7.4%（567 例患者中有 42 例）。多因素分析显示，女性和甲状腺微小乳头状癌（≤1cm）是跳跃性转移的独立危险因素，优势比（OR）[95%置信区间（CI）]分别为 2.29（1.02-5.16）和 2.84（1.46-5.16）。甲状腺内乳头状癌的播散和中央淋巴结清扫数的增加与跳跃性转移呈负相关，OR（95%CI）分别为 0.13（0.02-0.99）和 0.88（0.83-0.94）。相反，肿瘤较大、中央淋巴结转移、中央淋巴结清扫数增加、侧方淋巴结清扫数增加与甲状腺乳头状癌侧方淋巴结转移风险相关，OR（95%CI）分别为 1.67（1.08-2.59）、3.07（1.71-5.52）、1.25（1.14-1.37）和 1.07（1.04-1.10）。
结论：肿瘤较大、中央淋巴结转移以及中央淋巴结和侧方淋巴结清扫数的增加是甲状腺乳头状癌侧方淋巴结转移的预测因素。此外，甲状腺微小癌是跳跃性转移的独立危险因素。完整、全面的中央隔室清扫术可能会降低甲状腺乳头状癌跳跃性转移的假阳性检出率。
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