Wang Yunjun, Wang Dezhi, Chen Lili, Guo Kai, Sun Tuanqi
Department of Head & Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Int J Endocrinol. 2020 Sep 10;2020:7162793. doi: 10.1155/2020/7162793. eCollection 2020.
Although the American Thyroid Association (ATA) guidelines indicate that central lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) should be routinely dissected, pr-RLN dissection is often neglected due to the high risk of injury to the recurrent laryngeal nerve (RLN). The purpose of this study was to investigate the risk factors associated with LN-prRLN metastasis in patients with papillary thyroid carcinoma (PTC) by preoperative examination and the indications for LN-prRLN dissection.
A total of 1487 consecutive patients with PTC who underwent total thyroidectomy or right lobectomy plus isthmic resection with central LN dissection (CLND) were divided into two groups: patients with LN-prRLN dissection (group A) and patients without LN-prRLN dissection (group B). Clinicopathologic data were reviewed of the patients who were operated on by the same thyroid surgery team in the Department of Head Neck Surgery, Fudan University Shanghai Cancer Center (FUSCC) between August 2011 and May 2019. The relationships of LN-prRLN metastasis with clinicopathologic characteristics were analyzed by univariate and multivariate logistic regression.
The incidence of LN-prRLN metastasis was 34.1% (129/378). Univariate analysis showed that sex ( ≤ 0.001), tumor size ( ≤ 0.001), extrathyroidal extension (=0.002), concurrent Hashimoto's thyroiditis (=0.009), cLNMa (central lymph nodes anterior to the right recurrent laryngeal nerve) ( ≤ 0.001), cLNMa number ( ≤ 0.001), and lateral LN metastasis (LLNM) ( ≤ 0.001) were significantly associated with LN-prRLN metastasis in PTC. Multivariate logistic regression analysis revealed that tumor size (=0.039), cLNMa (=0.001), and LLNM (=0.025) were independent risk factors for LN-prRLN metastasis in patients with PTC. Although there was no significant difference between the two groups in recurrence, we found that 4 cases relapsed in the LN-prRLN compartment in group B, while none relapsed in group A.
LN-prRLN metastasis is often identified in patients with PTC. Patients with large tumor sizes, cLNMa and LLNM are at a high risk of LN-prRLN metastasis and should be recommended for careful LN-prRLN dissection.
尽管美国甲状腺协会（ATA）指南指出，应常规清扫右侧喉返神经后方的中央淋巴结（LN-prRLN），但由于喉返神经（RLN）损伤风险高，pr-RLN清扫术常被忽视。本研究旨在通过术前检查探讨与甲状腺乳头状癌（PTC）患者LN-prRLN转移相关的危险因素以及LN-prRLN清扫的指征。
共有1487例连续接受全甲状腺切除术或右侧叶切除术加峡部切除术并进行中央淋巴结清扫（CLND）的PTC患者被分为两组：接受LN-prRLN清扫的患者（A组）和未接受LN-prRLN清扫的患者（B组）。回顾了2011年8月至2019年5月在复旦大学附属肿瘤医院头颈外科由同一甲状腺手术团队进行手术的患者的临床病理资料。通过单因素和多因素逻辑回归分析LN-prRLN转移与临床病理特征之间的关系。
LN-prRLN转移的发生率为34.1%（129/378）。单因素分析显示，性别（≤0.001）、肿瘤大小（≤0.001）、甲状腺外侵犯（=0.002）、合并桥本甲状腺炎（=0.009）、cLNMa（右侧喉返神经前方的中央淋巴结）（≤0.001）、cLNMa数量（≤0.001）和侧方淋巴结转移（LLNM）（≤0.001）与PTC患者的LN-prRLN转移显著相关。多因素逻辑回归分析显示，肿瘤大小（=0.039）、cLNMa（=0.001）和LLNM（=0.025）是PTC患者LN-prRLN转移的独立危险因素。尽管两组在复发方面无显著差异，但我们发现B组有4例在LN-prRLN区域复发，而A组无一例复发。
PTC患者中常发现LN-prRLN转移。肿瘤大、有cLNMa和LLNM的患者LN-prRLN转移风险高，应建议仔细进行LN-prRLN清扫。
