Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, China.
Clin Endocrinol (Oxf). 2021 Oct;95(4):649-656. doi: 10.1111/cen.14491. Epub 2021 May 15.
Neck lymph node (LN) metastasis is a common feature of paediatric papillary thyroid cancer, and LN ratio (LNR) is defined as the ratio of the number of positive LNs excised to the total number of removed. Unlike in adults, few data are available regarding the clinical implication of LNR in the paediatric population. Our purpose was to investigate the association of LNR with clinical outcomes in paediatric papillary thyroid cancer.
DESIGN & METHODS: The study retrospectively reviewed 136 consecutive children and adolescents with papillary thyroid cancer and LN involvement but no initial distant metastasis. Initial treatment, included in all patients a total thyroidectomy with central and/or lateral neck dissection followed by radioactive iodine ablation. Within the neck dissections, total number of LNs removed, total positive LNs and LN ratios were determined. The effect of clinicopathologic characteristics and intraoperative findings on persistent and recurrent diseases were analysed by univariate and multivariate analyses.
Median number of positive LNs was 9, and median LNR was 0.4. During a median follow-up of 49 months (range, 12.0-139 months), persistent disease occurred in 43 (31.6%) patients. The multivariable analysis showed that age and LNR were the independent factors predictive of persistent disease. Patients with a LNR >0.34 exhibited a threefold higher risk of persistent disease after initial therapy than the counterparts (P = .02).
Our findings suggest that LNR was an independent determinant predictive of persistent disease after initial therapy in children and adolescents with papillary thyroid cancer.
颈部淋巴结（LN）转移是儿童甲状腺乳头状癌的常见特征，LN 比（LNR）定义为切除的阳性 LN 数量与切除的总 LN 数量之比。与成人不同，关于 LNR 在儿科人群中的临床意义的数据很少。我们的目的是研究 LNR 与儿童甲状腺乳头状癌临床结果的关系。
本研究回顾性分析了 136 例连续的儿童和青少年甲状腺乳头状癌伴 LN 受累但无初始远处转移的患者。所有患者均行全甲状腺切除术和中央及/或侧颈部清扫术，然后进行放射性碘消融术。在颈部清扫术中，确定了切除的 LN 总数、阳性 LN 总数和 LNR。通过单变量和多变量分析，分析了临床病理特征和术中发现对持续性和复发性疾病的影响。
中位阳性 LN 数为 9，中位 LNR 为 0.4。在中位随访 49 个月（范围为 12.0-139 个月）期间，43 例（31.6%）患者出现持续性疾病。多变量分析显示，年龄和 LNR 是预测持续性疾病的独立因素。LNR>0.34 的患者在初始治疗后发生持续性疾病的风险是对照组的三倍（P=0.02）。
我们的研究结果表明，LNR 是儿童和青少年甲状腺乳头状癌初始治疗后持续性疾病的独立预测因素。
