甲状腺乳头状癌中淋巴结比值和 Ki-67 表达的临床意义。

The Clinical Significance of Lymph Node Ratio and Ki-67 Expression in Papillary Thyroid Cancer.

机构信息

Department of Surgery, Sundsvall Hospital, 851 86, Sundsvall, Sweden.

Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 77, Stockholm, SE, Sweden.

出版信息

World J Surg. 2021 Jul;45(7):2155-2164. doi: 10.1007/s00268-021-06070-y. Epub 2021 Apr 7.

DOI:10.1007/s00268-021-06070-y

PMID:33825961

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8154824/

Abstract

BACKGROUND

The N stage in papillary thyroid cancer (PTC) is an important prognostic factor based on anatomical localization of cervical lymph nodes (LNs) only and not the extent of lymphatic metastasis. In this retrospective study, the clinical significance of lymph node ratio (LNR) and tumor cell proliferation in relation to the conventional classification of PTC was explored.

METHODS

Patients diagnosed with PTC at the Karolinska University Hospital in Stockholm, Sweden, during the years 2009-2011 were included. The LNR, defined as the number of metastatic LNs divided by the total number of LNs investigated, and the Ki-67 index were analyzed in relation to clinical data.

RESULTS

The median number of LN removed was 16 with the following N stage distribution: N0 (26%), N1a (45%), and N1b (29%). A Ki-67 index of ≥3% was significantly correlated with the presence of metastases and tumor recurrence with a sensitivity of 50% and specificity of 80% (p = 0.015). Lymph node ratio ≥21% was related to tumor recurrence with sensitivity of 89% and specificity of 70% (p = 0.006). Patients with LN metastases in the lateral cervical compartment only had significantly lower LNR (14.5%) compared to those with both central and lateral cervical metastases (39.5%) (p = 0.004) and exhibited no tumor recurrence. Increased Ki-67 index was significantly related to LNR ≥21% (p = 0.023) but was not associated with N stage.

CONCLUSIONS

The Ki-67 proliferation index and LNR may better reflect the malignant behavior of PTC compared to the anatomical classification of LN metastases solely.

摘要

背景

甲状腺乳头状癌（PTC）的 N 期是一个重要的预后因素，仅基于颈部淋巴结（LNs）的解剖定位，而不是淋巴转移的程度。在这项回顾性研究中，探讨了淋巴结比率（LNR）和肿瘤细胞增殖与 PTC 常规分类的关系的临床意义。

方法

纳入 2009 年至 2011 年在瑞典斯德哥尔摩卡罗林斯卡大学医院诊断为 PTC 的患者。分析 LNR（定义为转移的 LNs 数除以所研究的 LNs 总数）和 Ki-67 指数与临床数据的关系。

结果

中位切除的淋巴结数为 16 个，N 期分布如下：N0（26%）、N1a（45%）和 N1b（29%）。Ki-67 指数≥3%与转移和肿瘤复发显著相关，敏感性为 50%，特异性为 80%（p=0.015）。LNR≥21%与肿瘤复发相关，敏感性为 89%，特异性为 70%（p=0.006）。仅在侧颈部区域有淋巴结转移的患者的 LNR（14.5%）明显低于中央和侧颈部均有淋巴结转移的患者（39.5%）（p=0.004），且无肿瘤复发。Ki-67 增殖指数与 LNR≥21%显著相关（p=0.023），但与 N 期无关。