Chen Bao-Ding, Zhang Zheng, Wang Ke-Ke, Shang Meng-Yuan, Zhao Shuang-Shuang, Ding Wen-Bo, Du Rui, Yu Zhuan, Xu Xi-Ming
Department of Medical Ultrasound, Affiliated Hospital of Jiangsu University, Zhenjiang 212000, People's Republic of China.
Department of Medical Ultrasound, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing 210028, People's Republic of China.
Cancer Manag Res. 2019 Jul 30;11:7211-7217. doi: 10.2147/CMAR.S199921. eCollection 2019.
Prophylactic central lymph node dissection (CLND) in papillary thyroid microcarcinoma (PTMC) patients without clinical evidence of central lymph node metastasis (CLNM) remains controversial. The purpose of our study is to identify preoperative predictive factors for finding CLNM in Chinese PTMC patients, which may allow tailored CLND. We retrospectively reviewed 182 consecutive Chinese PMTC patients with negative central lymph nodes who underwent total thyroidectomy plus central neck dissection from October 2015 to December 2017. Chi-squared and multivariate analysis were performed to evaluate the association of CLNM with ultrasonographic and clinicopathologic characteristics. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the utility of markers in predicting CLNM. The CLNM was found in 39.0% (71 of 182) of cN0 PTMC patients. In multivariate analysis, tumor size>7 mm (OR: 3.636, 95% CI: 1.671-7.914), marked hypoechogenicity (OR: 2.686, 95% CI: 1.080-6.678), multifocality (OR: 4.184, 95% CI: 1.707-10.258) and BRAF mutation (OR: 5.339, 95% CI: 2.529-11.272) were independent predictors of CLNM. In ROC analysis integrating these predictors, the sensitivity was 63.4% and specificity was 80.2%, and the area under the ROC (AUC) was 0.755. In conclusion, we found tumor size>7 mm, marked hypoechogenicity, multifocality, and BRAF mutation were risk factors for CLNM. In term of these preoperative risk factors for CLNM, prophylactic CLND should be cautiously performed in cN0 PTMC patients.
对于无中央区淋巴结转移（CLNM）临床证据的甲状腺微小乳头状癌（PTMC）患者，预防性中央区淋巴结清扫（CLND）仍存在争议。我们研究的目的是确定中国PTMC患者中发现CLNM的术前预测因素，以便进行个体化的CLND。我们回顾性分析了2015年10月至2017年12月期间连续182例接受全甲状腺切除术加中央区颈清扫且中央区淋巴结阴性的中国PTMC患者。采用卡方检验和多因素分析来评估CLNM与超声及临床病理特征之间的关联。进行受试者操作特征（ROC）曲线分析以评估各指标预测CLNM的效用。在cN0 PTMC患者中，39.0%（182例中的71例）发现有CLNM。多因素分析显示，肿瘤大小>7 mm（OR：3.636，95%CI：1.671 - 7.914）、显著低回声（OR：2.686，95%CI：1.080 - 6.678）、多灶性（OR：4.184，95%CI：1.707 - 10.258）和BRAF突变（OR：5.339，95%CI：2.529 - 11.272）是CLNM的独立预测因素。在整合这些预测因素的ROC分析中，敏感性为63.4%，特异性为80.2%，ROC曲线下面积（AUC）为0.755。总之，我们发现肿瘤大小>7 mm、显著低回声、多灶性和BRAF突变是CLNM的危险因素。鉴于这些CLNM的术前危险因素，对于cN0 PTMC患者应谨慎进行预防性CLND。
