Yang Rui, Zhang Shoupeng, Huang Tao, Ming Jie, Yang Peng, Zhu Junling, Qu Fang
Breast and Thyorid Surgery,the Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Feb;35(2):137-140. doi: 10.13201/j.issn.2096-7993.2021.02.010.
To construct and verify a model of lymph node metastasis in cN0 stage thyroid micropapillary carcinoma. To explore the significance of thyroid gland lobectomy combined with prophylactic zone Ⅵ lymph node dissection in cN0 stage thyroid micropapillary carcinoma surgery. The clinical data of 670 patients with cN0 stage thyroid micropapillary carcinoma and area Ⅵ lymph node dissection were collected. All patients underwent the affected thyroid gland lobe±isthmus resection+ area Ⅵ lymphadenectomy on the same side. Logistic regression model was constructed by gender, age, size of thyroid papillary carcinoma, whether it was multifocal, whether it was encroaching on the membrane, and whether the lymph nodes in the central area were metastasized, and displayed by nomogram. Discrimination and prediction accuracy were evaluated by C-index, calibration curve and ROC curve. An internal validation group was used to test the fitted model. Analyze the lymph node metastasis trend according to the largest tumor diameter. Follow-up analysis of the reoperation was conducted to evaluate the effect of initial surgery. The rate of lymph node metastasis in area Ⅵ was 36.7%. Multiple regression analysis included three variables. The largest tumor diameter(<0.001), male(<0.001) and young(<0.001) were the main independent risk factors for lymph node metastasis. The reoperation rate of thyroid gland lobectomy combined with prophylactic zone Ⅵ lymph node dissection was low, and this surgical method might be safe and reliable for the treatment of cN0 stage thyroid micropapillary carcinoma, and it is worthy of promotion.
构建并验证cN0期甲状腺微小乳头状癌淋巴结转移模型。探讨甲状腺腺叶切除术联合预防性Ⅵ区淋巴结清扫术在cN0期甲状腺微小乳头状癌手术中的意义。收集670例行cN0期甲状腺微小乳头状癌及Ⅵ区淋巴结清扫术患者的临床资料。所有患者均行患侧甲状腺腺叶±峡部切除+同侧Ⅵ区淋巴结清扫术。以性别、年龄、甲状腺乳头状癌大小、是否多灶性、是否侵犯包膜及中央区淋巴结是否转移构建Logistic回归模型,并以列线图展示。通过C指数、校准曲线和ROC曲线评估判别能力和预测准确性。采用内部验证组对拟合模型进行检验。根据最大肿瘤直径分析淋巴结转移趋势。对再次手术进行随访分析以评估初次手术效果。Ⅵ区淋巴结转移率为36.7%。多元回归分析纳入3个变量。最大肿瘤直径(<0.001)、男性(<0.001)和年轻(<0.001)是淋巴结转移的主要独立危险因素。甲状腺腺叶切除术联合预防性Ⅵ区淋巴结清扫术的再次手术率较低,该手术方法治疗cN0期甲状腺微小乳头状癌可能安全可靠,值得推广。