超声联合免疫组织化学评估中央区淋巴结转移对甲状腺乳头状癌预后的价值
Value of Ultrasound Combined with Immunohistochemistry Evaluation of Central Lymph Node Metastasis for the Prognosis of Papillary Thyroid Carcinoma.
作者信息
Yao Xiaohua, Meng Ying, Guo Runsheng, Lu Guofeng, Jin Lin, Wang Yingchun, Yang Debin
机构信息
Departments of Ultrasound, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201800, People's Republic of China.
Departments of General Surgery, Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences, Shanghai 201800, People's Republic of China.
出版信息
Cancer Manag Res. 2020 Sep 22;12:8787-8799. doi: 10.2147/CMAR.S265756. eCollection 2020.
BACKGROUND
Papillary thyroid carcinoma (PTC) is often accompanied by cervical lymph node metastasis (LNM). The accuracy of the preoperative ultrasound diagnosis of central LNM (CLNM) is limited. LNM is a high-risk factor for local recurrence and may affect the prognosis. Factors not directly related to tumor proliferation are used for risk assessment in the tumor-node-metastasis (TNM) staging system for thyroid cancer. The present study aimed to investigate the value of ultrasound and immunohistochemistry in predicting the presence of CLNM and the prognosis of PTC.
PATIENTS AND METHODS
The ultrasound and immunohistochemistry features of 303 patients with first-ever PTC and who underwent surgery between 01/2014 to 12/2016 were analyzed, as well as the prognosis of the patients. Univariable and multivariable analyses were carried out to determine the risk factors of CLNM and recurrence.
RESULTS
Among 303 patients, 125 (41.3%) were pathologically confirmed with CLNM. Multivariable analysis showed that multifocality, taller-than-wide shape, grade III-IV blood flow, capsular invasion, Ki-67 >10%, p53 ≥5%, T2 or T3 stages were independent risk factors for CLNM. The median follow-up was 56 months. Cox regression analysis showed that age ≥55 years, maximum tumor diameter >20 mm, multifocality, capsular invasion, Ki-67 5-10%, Ki-67 >10%, p53 ≥5%, T3 stage and N1a stage were independent risk factors for PTC recurrence. The Kaplan-Meier showed that recurrence-free survival (RFS) was different according to age (P=0.017), tumor size multifocality, capsular invasion, Ki-67, p53, T stage and N stage (all P<0.001).
CONCLUSION
For PTC with rich blood flow, taller-than-wide shape, multifocality, capsular invasion, p53 ≥5%, Ki-67 >10%, T2 or T3 stages prophylactic CLNM dissection might be indicated. Age≥55 years, maximum tumor diameter >20 mm, multifocality, capsular invasion, high Ki-67, p53 ≥5%, T3 and N1a stages affected the clinical outcome.
背景
甲状腺乳头状癌（PTC）常伴有颈部淋巴结转移（LNM）。术前超声诊断中央区淋巴结转移（CLNM）的准确性有限。LNM是局部复发的高危因素，可能影响预后。在甲状腺癌的肿瘤-淋巴结-转移（TNM）分期系统中，使用与肿瘤增殖无直接关系的因素进行风险评估。本研究旨在探讨超声和免疫组化在预测CLNM的存在及PTC预后方面的价值。
患者与方法
分析了2014年1月至2016年12月期间首次诊断为PTC并接受手术的303例患者的超声和免疫组化特征以及患者的预后。进行单因素和多因素分析以确定CLNM和复发的危险因素。
结果
303例患者中，125例（41.3%）经病理证实有CLNM。多因素分析显示，多灶性、高宽比、III-IV级血流、包膜侵犯、Ki-67>10%、p53≥5%、T2或T3期是CLNM的独立危险因素。中位随访时间为56个月。Cox回归分析显示，年龄≥55岁、最大肿瘤直径>20 mm、多灶性、包膜侵犯、Ki-67 5-10%、Ki-67>10%、p53≥5%、T3期和N1a期是PTC复发的独立危险因素。Kaplan-Meier分析显示，无复发生存期（RFS）根据年龄（P=0.017）以及肿瘤大小、多灶性、包膜侵犯、Ki-67、p53、T分期和N分期而有所不同（均P<0.001）。
结论
对于血流丰富、高宽比、多灶性、包膜侵犯、p53≥5%、Ki-67>10%、T2或T3期的PTC，可能需要进行预防性CLNM清扫。年龄≥55岁、最大肿瘤直径>20 mm、多灶性、包膜侵犯、高Ki-67、p53≥5%、T3和N1a期会影响临床结局。
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