未接受预防性中央区颈淋巴结清扫术的甲状腺乳头状癌患者的长期预后
Long-term outcomes of patients with papillary thyroid cancer who did not undergo prophylactic central neck dissection.
作者信息
Huang Hui, Wu Ligang, Liu Wensheng, Liu Jie, Liu Yang, Xu Zhengang
机构信息
Department of Head and Neck Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Oncological Surgery, Cancer Hospital General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
出版信息
J Cancer Res Ther. 2020 Sep;16(5):1077-1081. doi: 10.4103/jcrt.JCRT_620_19.
AIMS
The role of prophylactic central neck dissection (CND) in the management of papillary thyroid carcinoma (PTC) is controversial. This study reports outcomes of an observational approach in PTC patients without clinical evidence of lymph node metastasis.
MATERIALS AND METHODS
Patients with PTC who had surgery (without prophylactic CND) between January 2000 and December 2008 were included in this study. Recurrence-free survival (RFS) and disease-specific survival (DSS) were calculated using the Kaplan-Meier method. Cox regression was used in multivariable models.
RESULTS
Out of 625 patients, 486 (77.8%) were female, 144 (23%) were aged 55 years or more, 73 (11.7%) had macroscopic extrathyroidal extension, and 79 (12.7%) had pT3 or pT4 disease. Samples were collected from 12 (1.9%) patients with lymph node metastasis in the perithyroidal tissue and 2 (0.3%) patients with lymph node metastasis in the lateral neck lymph tissue for frozen section examination. After a median follow-up of 104 months, the 10-year DSS and RFS rates were 99.7% and 90.2%, respectively. The 10-year lymph node recurrence rate in the central compartment was 2.7%. pT3/4 stage was an independent predictive factor for RFS (P < 0.001, hazard ratio 1.966, 95% confidence interval 1.446-2.673).
CONCLUSION
The outcomes of patients with clinically negative lymph nodes in the central compartment were favorable without prophylactic CND.
目的
预防性中央区颈淋巴结清扫术（CND）在甲状腺乳头状癌（PTC）治疗中的作用存在争议。本研究报告了对无临床淋巴结转移证据的PTC患者采用观察性方法的结果。
材料与方法
本研究纳入了2000年1月至2008年12月期间接受手术（未行预防性CND）的PTC患者。采用Kaplan-Meier法计算无复发生存期（RFS）和疾病特异性生存期（DSS）。多变量模型采用Cox回归分析。
结果
625例患者中，486例（77.8%）为女性，144例（23%）年龄在55岁及以上，73例（11.7%）有肉眼可见的甲状腺外侵犯，79例（12.7%）为pT3或pT4期疾病。对12例（1.9%）甲状腺周围组织有淋巴结转移的患者和2例（0.3%）侧颈淋巴结组织有淋巴结转移的患者进行了冰冻切片检查。中位随访104个月后，10年DSS率和RFS率分别为99.7%和90.2%。中央区10年淋巴结复发率为2.7%。pT3/4期是RFS的独立预测因素（P<0.001，风险比1.966，95%置信区间1.446-2.673）。
结论
中央区临床淋巴结阴性的患者在未行预防性CND的情况下预后良好。
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