The Third Affiliated Hospital of Soochow University, Changzhou First People'S Hospital, Changzhou, Jiangsu, China.
Clin Transl Oncol. 2019 Nov;21(11):1482-1491. doi: 10.1007/s12094-019-02076-0. Epub 2019 Mar 16.
Central lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) is common. But the association between primary tumor characteristics and specific features of metastatic lymph nodes in PTC has not been fully identified. Determining risk factors for LNM may help surgeons determine rational extent of lymph node dissection.
Data from 432 patients who underwent thyroidectomy with cervical lymph node dissection for PTC were retrospectively analyzed. The relationships between LNM to central compartment or lateral compartment and clinicopathologic factors were analyzed. Cox regression model was used to determine the risk factors for recurrence-free survival (RFS).
Central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM) were found in 216 (50.0%) and 65 (15.0%) patients, respectively. In the multivariate analysis for CLNM, patients < 45 years of age (OR 2.037, 95% CI 1.388-2.988, P < 0.001), extrathyroidal invasion (OR: 2.144, 95% CI 0.824-5.457, P = 0.011), vascular invasion (OR 13.817, 95% CI 1.694-112.693, P = 0.014), LLNM (OR 2.851, 95% CI 1.196-6.797, P = 0.014) and TNM Stage III-IV (OR 465.307, 95% CI 113.903-1900.826, P < 0.001) were independent predictors for high prevalence of CLNM. In the multivariate analysis for LLNM, tumor size more than 1cm (OR 3.474, 95% CI 1.728-6.985, P < 0.001) and CLNM (OR 5.532, 95% CI 2.679-11.425, P < 0.001) were independent predictors for high prevalence of LLNM. Moreover, tumor with T3-T4 stage, extrathyroidal invasion and CLNM were the significant factors related to the RFS.
For patients with pre-operative risk factors of LNM, an accurate preoperative evaluation of central compartment or lateral compartment is needed to find suspicious lymph nodes. And prophylactic lymph node dissection should be performed in patients with high risk of CLNM. Moreover, we suggest performing close follow-up for patients with high risk of RFS.
甲状腺乳头状癌（PTC）的中央淋巴结转移（CLNM）较为常见。但是，原发肿瘤特征与 PTC 转移性淋巴结的特定特征之间的关系尚未完全明确。确定 CLNM 的危险因素有助于外科医生确定合理的淋巴结清扫范围。
回顾性分析了 432 例接受甲状腺切除术和颈部淋巴结清扫术治疗 PTC 的患者的数据。分析了 CLNM 和侧方淋巴结转移（LLNM）与临床病理因素之间的关系。采用 Cox 回归模型确定无复发生存率（RFS）的危险因素。
216 例（50.0%）和 65 例（15.0%）患者分别发现中央淋巴结转移（CLNM）和侧方淋巴结转移（LLNM）。多变量分析显示，年龄<45 岁（OR 2.037，95%CI 1.388-2.988，P<0.001）、甲状腺外侵犯（OR：2.144，95%CI 0.824-5.457，P=0.011）、血管侵犯（OR 13.817，95%CI 1.694-112.693，P=0.014）、LLNM（OR 2.851，95%CI 1.196-6.797，P=0.014）和 TNM 分期 III-IV（OR 465.307，95%CI 113.903-1900.826，P<0.001）是 CLNM 高发生率的独立预测因子。在多变量分析中，肿瘤大小>1cm（OR 3.474，95%CI 1.728-6.985，P<0.001）和 CLNM（OR 5.532，95%CI 2.679-11.425，P<0.001）是 LLNM 高发生率的独立预测因子。此外，T3-T4 期肿瘤、甲状腺外侵犯和 CLNM 是与 RFS 相关的显著因素。
对于术前存在 LNM 危险因素的患者，需要对中央隔室或侧隔室进行准确的术前评估，以发现可疑的淋巴结。对于 CLNM 高危患者，应行预防性淋巴结清扫术。此外，我们建议对 RFS 高危患者进行密切随访。
