Fu Gui-Ming, Wang Zhao-Hui, Chen Yi-Bo, Li Chun-Hua, Zhang Yue-Jia, Li Xiao-Jing, Wan Quan-Xin
Head and Neck Surgery Center, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, People's Republic of China.
Department of Oncology, Chengdu Second People's Hospital, Chengdu 610041, People's Republic of China.
Cancer Manag Res. 2020 Aug 11;12:7143-7149. doi: 10.2147/CMAR.S248374. eCollection 2020.
With guidance from the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 8th edition, we explored the characteristics of central lymph node metastasis (CLNM) of papillary thyroid micro-carcinoma (PTMC) in elderly patients ≥55 years of age. Our goal was to provide references for establishing a lymph node dissection scheme in such patients.
We retrospectively analyzed the clinical data of thyroid cancer patients admitted to the Head and Neck Surgery Center of Sichuan Cancer Hospital, Chengdu, China, from January 2015 to September 2018. Then, we screened and analyzed eligible PTMC cases in strict accordance with our inclusion and exclusion criteria.
The study included 107 patients, including 24 men and 83 women. Median age was 59.99 ± 4.58 years. The maximum diameter range of the cancer foci was 4-10 mm, and the median was 7.59 ± 1.78 mm. Unilateral lobectomy had been performed in 32 cases, total thyroidectomy in 75 cases and lateral cervical lymph node dissection in 21 cases. There were 60 cases of CLNM (56.07%) and 13 cases of lateral cervical lymph node metastasis (12.10%). The sensitivity of preoperative ultrasound in predicting CLNM was 100%, but its accuracy was only 50.47%. Multivariate logistic regression analysis showed that multiple cancer foci (area under the curve [AUC] = 0.632), extra-thyroidal expansion of cancer focus (AUC = 0.721), and irregular nodules (AUC = 0.603) were independent risk factors for CLNM of PTMC in elderly patients (P < 0.05). Overall predictability for PTMC-CLNM was 80.30%.
在美国癌症联合委员会（AJCC）《癌症分期手册》第8版的指导下，我们探讨了年龄≥55岁的老年患者甲状腺微小乳头状癌（PTMC）中央淋巴结转移（CLNM）的特征。我们的目的是为制定此类患者的淋巴结清扫方案提供参考。
我们回顾性分析了2015年1月至2018年9月在中国成都四川省肿瘤医院头颈外科中心收治的甲状腺癌患者的临床资料。然后，我们严格按照纳入和排除标准筛选并分析符合条件的PTMC病例。
该研究纳入了107例患者，其中男性24例，女性83例。中位年龄为59.99±4.58岁。癌灶最大直径范围为4 - 10mm，中位值为7.59±1.78mm。32例行单侧甲状腺叶切除术，75例行全甲状腺切除术，21例行侧颈淋巴结清扫术。有60例发生CLNM（56.07%），13例发生侧颈淋巴结转移（12.10%）。术前超声预测CLNM的敏感性为100%，但其准确性仅为50.47%。多因素logistic回归分析显示多灶癌（曲线下面积[AUC]=0.632）、癌灶甲状腺外扩展（AUC = 0.721）和结节不规则（AUC = 0.603）是老年PTMC患者CLNM的独立危险因素（P<0.05）。PTMC - CLNM的总体预测能力为80.30%。
1）不建议将术前彩色多普勒超声作为PTMC患者颈淋巴结清扫的依据。2）对于多灶癌、结节不规则以及癌灶有甲状腺外扩展的老年PTMC患者，建议进行预防性中央淋巴结清扫。3）对于低风险老年PTMC患者的非手术观察应谨慎选择。
