Jin Kai, Li Liang, Liu Yahang, Wang Xudong
Department of Maxillofacial & E.N.T Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
Department of Thyroid Neoplasms Surgery, Inner Mongolia People's Hospital, Hohhot, China.
Gland Surg. 2020 Dec;9(6):2026-2034. doi: 10.21037/gs-20-699.
Currently, there are few studies on the characteristics of lymph node metastasis in the central region in patients with preoperative negative lymph node (cN0) papillary thyroid carcinoma (PTC) coexistent with Hashimoto's thyroiditis (HT). There is still a significant controversy on whether to perform prophylactic central compartment lymph node dissection for T1/T2 cN0 PTC. Therefore, we aimed to investigate the characteristics and risk factors of central compartment lymph node metastasis in cN0 PTC (T1 or T2 stage) coexists with HT.
From Jun. 2015 to Apr. 2019, the clinicopathological data of 354 patients with stage T1/T2 cN0 PTC admitted to the thyroid tumor surgery of Inner Mongolia People's Hospital were analyzed retrospectively. All patients underwent central compartment lymph node dissection. According to the results of the postoperative pathological examination, the patients were divided into two groups: PTC group (n=236) and PTC coexistent with the HT group (n=118).
The proportion of PTC patients with HT was 33.33% (118/354) in T1/T2 cN0 PTC patients; most of them were women. The levels of serum thyrotropin, antithyroglobulin antibody, and thyroid peroxidase antibody in PTC coexistent with HT group are higher than those in the PTC group (P<0.05). The number of lymphadenectomies in PTC coexistent with HT group was more than that in PTC alone group (P<0.05). Univariate analysis showed that antithyroglobulin antibody positive, tumor diameter >1 cm, and multifocal cancer in T1/T2 stage cN0 PTC coexistent with HT group were all correlated with lymph node metastasis in the central region (P<0.05). Logistic regression analysis showed that tumor diameter >1 cm, and multifocal cancer were the risk factors of central compartment lymph node metastasis in patients with T1/T2 stage cN0 PTC coexistent with HT (P<0.05).
HT is not a relevant factor of central lymph node metastasis in T1/T2 cN0 PTC; regardless of the presence or absence of HT, tumor diameter >1 cm and multifocal cancer are risk factors for central lymph node metastasis in patients with T1/T2 cN0 PTC. Therefore, preventive lymph node dissection in the central region should be conducted actively during the operation.
目前，关于术前淋巴结阴性（cN0）的甲状腺乳头状癌（PTC）合并桥本甲状腺炎（HT）患者中央区淋巴结转移特征的研究较少。对于T1/T2 cN0 PTC是否行预防性中央区淋巴结清扫仍存在重大争议。因此，我们旨在探讨cN0 PTC（T1或T2期）合并HT患者中央区淋巴结转移的特征及危险因素。
回顾性分析2015年6月至2019年4月内蒙古自治区人民医院甲状腺肿瘤外科收治的354例T1/T2 cN0 PTC患者的临床病理资料。所有患者均行中央区淋巴结清扫。根据术后病理检查结果，将患者分为两组：PTC组（n=236）和PTC合并HT组（n=118）。
T1/T2 cN0 PTC患者中合并HT的PTC患者比例为33.33%（118/354）；大多数为女性。PTC合并HT组患者的血清促甲状腺激素、抗甲状腺球蛋白抗体和甲状腺过氧化物酶抗体水平高于PTC组（P<0.05）。PTC合并HT组的淋巴结清扫数量多于单纯PTC组（P<0.05）。单因素分析显示，PTC合并HT组T1/T2期cN0 PTC患者抗甲状腺球蛋白抗体阳性、肿瘤直径>1 cm及多灶癌均与中央区淋巴结转移相关（P<0.05）。Logistic回归分析显示，肿瘤直径>1 cm及多灶癌是T1/T2期cN0 PTC合并HT患者中央区淋巴结转移的危险因素（P<0.05）。
HT不是T1/T2 cN0 PTC中央区淋巴结转移的相关因素；无论是否合并HT，肿瘤直径>1 cm及多灶癌都是T1/T2 cN0 PTC患者中央区淋巴结转移的危险因素。因此，术中应积极行中央区预防性淋巴结清扫。
