Li Chuang, Meng Zhao-Zhong, Qin Jian-Wu, Qiu Xin-Guang
Department of Thyroid and Neck, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou 450003, China.
Department of Thyroid Surgery, The First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China.
J Oncol. 2021 Aug 18;2021:5562065. doi: 10.1155/2021/5562065. eCollection 2021.
To explore the risk factors of level V lymphatic metastasis in papillary thyroid carcinoma (PTC) patients with pN1b.
Patients were selected if they presented with a suspicious level III or IV lymph node metastasis and underwent surgery by hemi or total thyroidectomy with a lymph node dissection (levels III, IV, VI, and VII). For these patients, if frozen section showed a positive level III or IV node, then levels II and V nodes were resected. Univariate analysis was performed using the chi-square test for some factors, including age, sex, tumor location, multifocal lesions, tumor size, local invasion of primary focus, status of cervical lymphatic metastasis, TNM staging, tumor deposits (independent tumor nodules), and the metastasis to more than 5 central lymph nodes. Then, the factors with statistical significance indicated by the above univariate analysis underwent multivariate analysis.
Univariate analysis indicated that the level V lymphatic metastasis was significantly associated with simultaneous metastases to levels II, III, and IV, simultaneous metastases to levels III and IV, and tumor deposits (all < 0.05), but it was not significantly associated with age, sex, tumor location, multifocal lesions, tumor size, local invasion of primary focus, other cervical lymphatic metastasis, TNM staging, and the metastases to more than 5 central lymph nodes (all > 0.05). Multivariate analysis suggested that the simultaneous metastases to levels III and IV and tumor deposits were the risk factors of level V lymphatic metastasis.
The simultaneous metastases to levels III and IV and tumor deposits are independent risk factors of level V lymphatic metastasis. The patients with pN1b PTC who have simultaneous metastases to levels III and IV or/and tumor deposits may have the risk of level V lymph node metastasis.
探讨pN1b期甲状腺乳头状癌（PTC）患者Ⅴ区淋巴结转移的危险因素。
选取出现可疑Ⅲ或Ⅳ区淋巴结转移并接受半甲状腺切除术或全甲状腺切除术加淋巴结清扫术（Ⅲ、Ⅳ、Ⅵ和Ⅶ区）的患者。对于这些患者，如果冰冻切片显示Ⅲ或Ⅳ区淋巴结阳性，则切除Ⅱ区和Ⅴ区淋巴结。对年龄、性别、肿瘤位置、多灶性病变、肿瘤大小、原发灶局部侵犯、颈部淋巴结转移情况、TNM分期、肿瘤灶（独立肿瘤结节）以及转移至5个以上中央淋巴结等因素进行单因素分析，采用卡方检验。然后，对上述单因素分析中有统计学意义的因素进行多因素分析。
单因素分析表明，Ⅴ区淋巴结转移与Ⅱ、Ⅲ和Ⅳ区同时转移、Ⅲ和Ⅳ区同时转移以及肿瘤灶显著相关（均P<0.05），但与年龄、性别、肿瘤位置、多灶性病变、肿瘤大小、原发灶局部侵犯、其他颈部淋巴结转移、TNM分期以及转移至5个以上中央淋巴结均无显著相关（均P>0.05）。多因素分析提示，Ⅲ和Ⅳ区同时转移以及肿瘤灶是Ⅴ区淋巴结转移的危险因素。
Ⅲ和Ⅳ区同时转移以及肿瘤灶是Ⅴ区淋巴结转移的独立危险因素。pN1b期PTC患者若出现Ⅲ和Ⅳ区同时转移或/和肿瘤灶，可能存在Ⅴ区淋巴结转移风险。
