Department of Otolaryngology, Head & Neck Surgery and Maxillofacial Surgery, Tel-Aviv Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Department of Otolaryngology, Head & Neck Surgery, Rabin Medical Center, Petach Tikva, Affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
J Surg Oncol. 2021 Feb;123(2):456-461. doi: 10.1002/jso.26299. Epub 2020 Dec 1.
Papillary thyroid cancer (PTC) usually metastasizes via lymphatic channels in a sequential fashion, first to the central compartment, followed by the lateral neck. PTC patients diagnosed with lateral neck disease (N1b) without proof for central involvement traditionally undergo prophylactic central neck dissection (pCND). However, substantial evidence on outcomes to support this approach is lacking.
We conducted a dual center retrospective study to compare the rate of central neck recurrence between N1b PTC patients undergoing pCND and those spared pCND. All patients diagnosed with N1b PTC who underwent total thyroidectomy and lateral neck dissections with or without pCND between January 1998 and December 2015 were included in this study. The rates of central neck recurrences were compared between the groups.
The 111 patients who met the inclusion criteria were 44 females (39.6%) and 67 males (60.4%), with a mean age of 50.2 ± 17.7 years, and a mean follow-up of 10.2 ± 5.3 years. Sixty patients (54.1%) underwent a pCND and 51 patients (45.9%) did not (non-pCND). During follow-up, 18 patients (16.2%) had level VI recurrences, 13 in the pCND group and 5 in the non-pCND group. Cox-regression models with propensity scoring did not reveal any inclination or an advantage for performing pCND.
The present study demonstrated no advantage in performing pCND to prevent central neck recurrence among PTC patients with lateral neck involvement only. These findings question the need for pCND in patients without clinical evidence of central neck disease.
甲状腺乳头状癌（PTC）通常通过淋巴道顺序转移，首先转移到中央区，然后转移到侧颈部。传统上，对于诊断为侧颈部疾病（N1b）且无中央受累证据的 PTC 患者，行预防性中央区颈部清扫术（pCND）。然而，缺乏支持这种方法的大量结果证据。
我们进行了一项双中心回顾性研究，比较了行 pCND 的 N1b 型 PTC 患者与免于行 pCND 的患者之间中央区颈部复发率。本研究纳入了 1998 年 1 月至 2015 年 12 月期间行全甲状腺切除术及侧颈部清扫术（伴或不伴 pCND）且诊断为 N1b PTC 的所有患者。比较了两组患者中央区颈部复发率。
符合纳入标准的 111 例患者中，女性 44 例（39.6%），男性 67 例（60.4%）；年龄 50.2±17.7 岁，随访时间 10.2±5.3 年。60 例行 pCND（54.1%），51 例行非 pCND（45.9%）。随访期间，6 级有 18 例（16.2%）复发，pCND 组 13 例，非 pCND 组 5 例。经倾向评分匹配的 Cox 回归模型未显示行 pCND 存在倾向性或优势。
本研究显示，对于仅有侧颈部受累的 PTC 患者，行 pCND 并不能预防中央区颈部复发。这些结果质疑对于无中央区颈部疾病临床证据的患者行 pCND 的必要性。
