Medical Faculty, Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), University of Duisburg-Essen, Essen, Germany.
Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany.
Br J Surg. 2020 May;107(6):695-704. doi: 10.1002/bjs.11444. Epub 2020 Feb 28.
The impact of number of node metastases versus metastatic lymph node ratio versus AJCC node category on biochemical cure in medullary thyroid cancer (MTC) is not well defined.
Multivariable logistic regression analysis was used to determine clinical and histopathological variables that contribute to biochemical cure in node-positive MTC.
Some 584 of 1026 patients with MTC underwent systematic lymph node dissections for node-positive disease; 27·4 per cent (54 of 197) were biochemically cured after the initial operation and 13·5 per cent (42 of 310 patients) after repeat surgery. Cured patients had significantly less extrathyroid extension (11-14 versus 33·2-55·6 per cent), fewer lymph node metastases (median 2-4 versus 12-16), a lower metastatic lymph node ratio (median 0·05-0·08 versus 0·23-0·28), and were less likely to have AJCC pN1b disease (56-76 versus 89·9-91·6 per cent) and distant metastases (0 versus 28·4-37·1 per cent) than patients who were not cured. Biochemical cure curves advanced steadily up to 7-12 node metastases and a metastatic lymph node ratio of 0·33, eventually levelling off after 16-17 node metastases and metastatic lymph node ratios of 0·45-0·65. In logistic regression analysis, number of lymph node metastases (odds ratio (OR) 17·24 for more than 20 metastases, OR 5·28 for 11-20 metastases, OR 2·22 for 6-10 metastases), preoperative basal serum calcitonin (OR 6·24 for over 1000 pg/ml), reoperation (OR 5·34) and extrathyroid extension (OR 2·42) independently predicted failure to reach biochemical cure.
Number of lymph node metastases, unlike metastatic lymph node ratio or AJCC node category, determines likelihood of biochemical cure after initial and repeat surgery for node-positive MTC.
甲状腺髓样癌（MTC）中转移淋巴结数量、转移淋巴结比例和 AJCC 淋巴结分类对生化治愈的影响尚不清楚。
采用多变量逻辑回归分析确定有助于阳性淋巴结 MTC 生化治愈的临床和组织病理学变量。
1026 例 MTC 患者中有 584 例因阳性淋巴结疾病行系统淋巴结清扫术；初始手术后 27.4%（54/197）和重复手术后 13.5%（42/310 例）生化治愈。治愈患者甲状腺外侵犯明显减少（11-14%比 33.2-55.6%），淋巴结转移更少（中位数 2-4 个比 12-16 个），转移淋巴结比例更低（中位数 0.05-0.08 比 0.23-0.28），AJCC pN1b 疾病（56-76%比 89.9-91.6%）和远处转移（0%比 28.4-37.1%）的可能性也较低。生化治愈曲线稳定上升至 7-12 个淋巴结转移和 0.33 的转移淋巴结比例，在 16-17 个淋巴结转移和 0.45-0.65 的转移淋巴结比例后逐渐稳定。在逻辑回归分析中，淋巴结转移数量（转移超过 20 个的优势比（OR）17.24，转移 11-20 个的 OR 5.28，转移 6-10 个的 OR 2.22），术前基础降钙素（超过 1000pg/ml 的 OR 6.24），再次手术（OR 5.34）和甲状腺外侵犯（OR 2.42）独立预测初始和重复手术后生化治愈失败。
与转移淋巴结比例或 AJCC 淋巴结分类不同，淋巴结转移数量决定了阳性淋巴结 MTC 初始和重复手术后生化治愈的可能性。
