Zhu Jiang, Huang Rui, Yu Ping, Hu Daixing, Ren Haoyu, Huang Chun, Su Xinliang
Department of Endocrine and Breast Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Gland Surg. 2021 Jan;10(1):73-82. doi: 10.21037/gs-20-521.
As is known, identifying risk factors precisely for lymph node metastasis (LNM) plays a vital role in initial treatment for papillary thyroid carcinoma (PTC). Nonetheless, whether Delphian lymph node (DLN) metastasis has value in predicting LNM remains an open question. This study covered a sample of 1,575 patients, which is the largest sample group so far, aiming to assess the predictive validity of DLN metastasis in PTC.
This retrospective cohort study was conducted with 1,575 eligible PTC patients who underwent thyroid operation between July 2013 and December 2018 and clinicopathologic parameters of patients with DLN metastasis were compared with those without DLN metastasis.
The incidence of DLN metastasis, according to our research samples, is 24.4% (384/1,575 patients). And results show that DLN positivity was closely associated with adverse prognostic factors including younger age, larger tumor size, extrathyroid extension, tumor location in the isthmus or upper lobe of the thyroid, number of LNM >5, higher recurrence. After carefully adjusting important confounding factors, we find that in multivariate logistic regression analyses, DLN metastasis is an independent predictor for both central LNM (CLNM, adjusted OR =7.81, P<0.001) and lateral LNM (LLNM, adjusted OR =3.40, P<0.001). Moreover, the stratified analyses also show convincing evidence of a positive correlation between DLN metastasis and LNM in levels II-IV in the vast majority of subgroups.
The present study suggests that DLN metastasis is an independent risk factor for CLNM and LLNM of levels II-IV. The cervical lymph nodes should be meticulously evaluated to guide tailored treatment during operation in patients with DLN involvement.
众所周知，准确识别甲状腺乳头状癌（PTC）淋巴结转移（LNM）的危险因素对其初始治疗至关重要。然而，Delphian淋巴结（DLN）转移在预测LNM方面是否具有价值仍是一个悬而未决的问题。本研究纳入了1575例患者，这是迄今为止最大的样本组，旨在评估DLN转移在PTC中的预测效度。
本回顾性队列研究纳入了1575例符合条件的PTC患者，这些患者于2013年7月至2018年12月接受了甲状腺手术，并比较了有DLN转移患者与无DLN转移患者的临床病理参数。
根据我们的研究样本，DLN转移的发生率为24.4%（384/1575例患者）。结果显示，DLN阳性与不良预后因素密切相关，包括年龄较小、肿瘤较大、甲状腺外侵犯、肿瘤位于甲状腺峡部或上叶、LNM数量>5、复发率较高。在仔细调整重要的混杂因素后，我们发现在多因素逻辑回归分析中，DLN转移是中央区LNM（CLNM，调整后的OR=7.81，P<0.001）和侧方区LNM（LLNM，调整后的OR=3.40，P<0.001）的独立预测因素。此外，分层分析也显示了绝大多数亚组中DLN转移与Ⅱ-Ⅳ区LNM之间存在正相关的令人信服的证据。
本研究表明，DLN转移是CLNM和Ⅱ-Ⅳ区LLNM的独立危险因素。对于有DLN受累的患者，术中应仔细评估颈部淋巴结，以指导个体化治疗。
