Department of Otolaryngology - Head & Neck Surgery, Thyroid and Parathyroid Endocrine Surgical Division, Harvard Medical School, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
Laryngoscope. 2022 Sep;132(9):1883-1887. doi: 10.1002/lary.30084. Epub 2022 Mar 1.
Papillary thyroid carcinoma (PTC) accounts for the majority of thyroid malignancies; risk of PTC recurrence over a 30-year period is approximately 30%, of which 70% occur as nodal metastases. Patients with nodal disease who are treated with therapeutic dissection are at higher risk for recurrence, but optimal nodal yield has not been defined. We aim to determine variables predictive of nodal recurrence of PTC within the first 5 years of surgery, with a focus on lymph node ratio (LNR), to inform clinical decision-making.
Retrospective chart review identified 41 patients with nodal recurrence of PTC and 284 without nodal recurrence following thyroid surgery from 2000 to 2015. Cohorts were compared with regards to clinical history, surgical findings, and tumor characteristics.
The fraction of the patients who underwent therapeutic central or lateral lymph node dissection was significantly higher in the nodal recurrence cohort. Maximum tumor size, presence of extrathyroidal extension, largest lymph node focus, LNR, postoperative thyroglobulin level, and administration of postoperative radioactive iodine were significantly increased in the PTC nodal recurrence group. LNR greater than 0.3 held the highest level of significance as a binary cutoff and captured the larger proportion of patients in the nodal recurrence cohort (68.3%).
This study demonstrates characteristics to help assess risk of nodal recurrence of PTC and suggests LNR of lower than 0.3 is optimal to reduce risk of recurrence. The next steps include cohort studies to validate findings and weight variable analysis to optimize the extent of surgical therapeutic dissection.
4 Laryngoscope, 132:1883-1887, 2022.
甲状腺乳头状癌（PTC）占甲状腺恶性肿瘤的大部分；在 30 年内，PTC 复发的风险约为 30%，其中 70%为淋巴结转移。接受治疗性解剖的淋巴结疾病患者复发风险更高，但尚未确定最佳的淋巴结产量。我们旨在确定手术前 5 年内 PTC 淋巴结复发的预测变量，重点是淋巴结比率（LNR），为临床决策提供信息。
回顾性图表审查从 2000 年至 2015 年确定了 41 例 PTC 淋巴结复发患者和 284 例无淋巴结复发患者。比较了两组患者的临床病史、手术发现和肿瘤特征。
在淋巴结复发组中，接受治疗性中央或侧方淋巴结解剖的患者比例明显更高。最大肿瘤大小、甲状腺外延伸存在、最大淋巴结焦点、LNR、术后甲状腺球蛋白水平和术后放射性碘治疗在 PTC 淋巴结复发组中显著增加。LNR 大于 0.3 作为二进制截止值具有最高的显著性水平，并捕获了淋巴结复发组中更大比例的患者（68.3%）。
本研究表明了一些特征可以帮助评估 PTC 淋巴结复发的风险，并表明 LNR 低于 0.3 是降低复发风险的最佳选择。下一步包括队列研究来验证研究结果和变量分析，以优化手术治疗性解剖的范围。
4 级喉镜，132:1883-1887，2022 年。
