Shen Guohua, Ma Huan, Huang Rui, Kuang Anren
Department of Nuclear Medicine, Laboratory of Clinical Nuclear Medicine, West China Hospital, Sichuan University.
Sichuan New Radiopharmaceuticals Technology Co. LTD., Chengdu, People's Republic of China.
Nucl Med Commun. 2020 Jan;41(1):5-10. doi: 10.1097/MNM.0000000000001119.
Large-volume lymph node metastasis (LNM) has been believed to be an important predictor for recurrence in papillary thyroid microcarcinoma (PTMC). However, the clinical predictors for large-volume LNM have yet to be established. This study aimed to determine clinical predictors for large-volume LNM in clinically node-negative PTMC.
A total of 947 clinically N0 PTMC patients who received total thyroidectomy with lymph node dissection and radioiodine therapy were included. Based on the LNM status, they were divided into two groups: large-volume LNM and small-volume LNM including those patients without LNM. The association between age, gender and other clinical factors and large-volume LNM were investigated. The recurrence-free survival was also compared among these groups.
We found that male gender [odds ratio (OR) = 1.865, P = 0.015], young age (OR = 2.743, P < 0.001) and extrathyroid extension (OR = 5.352, P < 0.001) were independent predictors for high prevalence of large-volume LNM. Young (<40 years) and male patients tended to have large-volume LNM with the highest prevalence of 17.20%, whereas old (≥55 years) and female patients had the lowest prevalence of 2.02%. After median follow-up of 71 months, the recurrence rate was significantly higher for large-volume LNM compared with small-volume LNM (15.48 vs 0.72%, P < 0.05). Large-volume LNM status was significantly associated with decreased recurrence-free probability, while small-volume LNM had little effect on the recurrence-free survival.
This study showed that in clinically node-negative PTMC, young male patients had a greater incidence of large-volume LNM.
大量淋巴结转移（LNM）被认为是甲状腺微小乳头状癌（PTMC）复发的重要预测指标。然而，大量LNM的临床预测因素尚未确立。本研究旨在确定临床淋巴结阴性PTMC中大量LNM的临床预测因素。
共纳入947例接受甲状腺全切除术加淋巴结清扫及放射性碘治疗的临床N0期PTMC患者。根据LNM状态，将他们分为两组：大量LNM组和少量LNM组（包括无LNM的患者）。研究年龄、性别和其他临床因素与大量LNM之间的关联。还比较了这些组之间的无复发生存率。
我们发现男性[比值比（OR）=1.865，P=0.015]、年轻（OR=2.743，P<0.001）和甲状腺外侵犯（OR=5.352，P<0.001）是大量LNM高发生率的独立预测因素。年轻（<40岁）男性患者倾向于有大量LNM，发生率最高为17.20%，而老年（≥55岁）女性患者发生率最低为2.02%。中位随访71个月后，大量LNM组的复发率显著高于少量LNM组（15.48%对0.72%，P<0.05）。大量LNM状态与无复发概率降低显著相关，而少量LNM对无复发生存几乎没有影响。
本研究表明，在临床淋巴结阴性的PTMC中，年轻男性患者大量LNM的发生率更高。
