Huang Ziyang, Song Muye, Wang Shujie, Huang Jianhao, Shi Hongyan, Huang Yijie, Yin Ying, Liu Yongchen, Wu Zeyu
Department of General Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Shantou University Medical College, Shantou 515041, China.
Ann Transl Med. 2020 Mar;8(6):389. doi: 10.21037/atm.2019.10.92.
Lymph node metastasis of papillary thyroid carcinoma (PTC) was a significant risk factor of local recurrence and distant metastasis, and our study aimed to identify predictive factors of skip metastasis in PTC, helping surgeons to build a strategy when facing patients in N1b stage with clinical central lymph node-negative.
A total of 304 patients who underwent total thyroidectomy with central and lateral lymph node dissection and were diagnosed PTC with lateral lymph node metastasis (LLNM) in the Department of General Surgery at Guangdong Provincial People's Hospital were enrolled. We collected clinicopathological characteristics and analyzed their correlation with skip metastasis by univariate and multivariate analysis.
The incidence of skip metastasis in PTC was 14.8%. Univariate analysis showed that age, tumor diameter, primary tumor location, and preoperative serum thyroglobulin (Tg) were risk factors. Age (P=0.049, OR =3.418), primary tumor location (P<0.001, OR =7.279), and Tg (P=0.038, OR =9.412) were independent predictors in PTC by multivariate analysis.
Skip metastasis of PTC was significantly associated with preoperative serum Tg ≤77 ng/mL, tumor diameter ≤10 mm, age ≥55, and tumor located in the upper lobe. It is the first time to demonstrate that Tg is associated with skip metastasis of PTC.
甲状腺乳头状癌（PTC）的淋巴结转移是局部复发和远处转移的重要危险因素，本研究旨在确定PTC中跳跃转移的预测因素，帮助外科医生在面对临床中央淋巴结阴性的N1b期患者时制定策略。
选取广东省人民医院普通外科304例行全甲状腺切除术并进行中央和侧方淋巴结清扫且诊断为PTC伴侧方淋巴结转移（LLNM）的患者。收集临床病理特征，并通过单因素和多因素分析其与跳跃转移的相关性。
PTC中跳跃转移的发生率为14.8%。单因素分析显示年龄、肿瘤直径、原发肿瘤位置和术前血清甲状腺球蛋白（Tg）是危险因素。多因素分析显示年龄（P=0.049，OR =3.418）、原发肿瘤位置（P<0.001，OR =7.279）和Tg（P=0.038，OR =9.412）是PTC跳跃转移的独立预测因素。
PTC的跳跃转移与术前血清Tg≤77 ng/mL、肿瘤直径≤10 mm、年龄≥55岁及肿瘤位于上叶显著相关。首次证明Tg与PTC的跳跃转移有关。
