Shou Jin-Duo, Li Fei-Bo, Shi Liu-Hong, Zhou Liang, Xie Lei, Wang Jian-Biao
Departments of Diagnostic Ultrasound and Echocardiography, the Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou.
Second Department of General Surgery, Zhejiang Putuo Hospital, Zhoushan.
Medicine (Baltimore). 2020 Sep 18;99(38):e22338. doi: 10.1097/MD.0000000000022338.
The ability to identify patients with aggressive papillary thyroid microcarcinoma (PTMC) from the low-risk patients is critical to planning proper management of PTMC. Lymph node metastases showed association with recurrence and low survival rate, especially in patients with >5 or ≥2 mm metastatic lymph nodes. Therefore, this study aimed to investigate the preoperatively predictive factors of non-small-volume (metastatic lymph nodes >5 or ≥2 mm in size) central lymph node metastases (NSVCLNM) in PTMC patients. A total of 420 patients with clinically node-negative (cN0) PTMC without extrathyroidal extension underwent thyroidectomy plus central neck dissection (CND) between January 2013 and December 2015, were retrospectively analyzed. Of the 420 patients, 33 (7.9%) had NSVCLNM. The 5-year recurrence-free survival was significantly less in cN0 PTMC patients with NSVCLNM, when compared with patients without NSVCLNM (80.8% vs 100%, P < .001). Multivariate logistic regression revealed age ≤36 years (P < .001), male sex (P = .002), ultrasonic tumor sizes of >0.65 cm (P < .001), and ultrasonic multifocality (P = .039) were independent predictive factors of NSVCLNM. A prediction equation (Y = 1.714 × age + 1.361 × sex + 1.639 × tumor size + 0.842 × multifocality -5.196) was developed, with a sensitivity (69.7%) and a specificity (84.0%), respectively, at an optimal cutoff point of -2.418. In conclusion, if the predictive value was >-2.418 according to the equation, immediate surgery including CND rather than active surveillance might be considered for cN0 PTMC patients.
从低风险患者中识别侵袭性甲状腺微小乳头状癌（PTMC）患者的能力对于规划PTMC的恰当治疗至关重要。淋巴结转移与复发及低生存率相关，尤其是在有>5个或≥2 mm转移性淋巴结的患者中。因此，本研究旨在探讨PTMC患者术前非小体积（转移性淋巴结大小>5个或≥2 mm）中央区淋巴结转移（NSVCLNM）的预测因素。回顾性分析了2013年1月至2015年12月期间共420例临床淋巴结阴性（cN0）且无甲状腺外侵犯的PTMC患者，这些患者均接受了甲状腺切除术加中央区颈淋巴结清扫术（CND）。在这420例患者中，33例（7.9%）发生了NSVCLNM。与无NSVCLNM的患者相比，发生NSVCLNM的cN0 PTMC患者的5年无复发生存率显著更低（80.8%对100%，P<0.001）。多因素逻辑回归显示年龄≤36岁（P<0.001）、男性（P = 0.002）、超声肿瘤大小>0.65 cm（P<0.001）以及超声多灶性（P = 0.039）是NSVCLNM的独立预测因素。建立了一个预测方程（Y = 1.714×年龄 + 1.361×性别 + 1.639×肿瘤大小 + 0.842×多灶性 - 5.196），在最佳截断点-2.418时，敏感性为69.7%，特异性为84.0%。总之，如果根据该方程预测值>-2.418，对于cN0 PTMC患者可能考虑立即进行包括CND在内的手术而非积极监测。
