Department of General and Endocrine Surgery, Pitié Salpêtrière Hospital, APHP, Sorbonne University, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Thyroid and Endocrine Tumor Unit, Pitié Salpêtrière Hospital, APHP, Sorbonne University, Paris, France.
Langenbecks Arch Surg. 2022 Nov;407(7):3025-3030. doi: 10.1007/s00423-022-02604-7. Epub 2022 Jul 12.
Lymph node metastasis (N1) is a prognostic factor for disease recurrence in papillary thyroid carcinoma (PTC) patients. Skip metastasis is defined as only lateral N1 with negative central lymph nodes (LNs).
The aim of this study was to explore the outcome of PTC patients with skip N1.
All patients who underwent a total thyroidectomy with ipsilateral central and lateral LN dissection for PTC from 1999 to 2019 in a high-volume endocrine surgery centre were included in this study.
Demographic and outcomes-recurrence and disease-specific survival (DSS)-were compared between three groups: N1a (central N1 only), N1b-CL (central and lateral N1), and N1b-Skip (lateral N1 without central LN involvement).
During the study period, 3046 patients had surgery for PTC, including 1138 with N1 (37%, 860 women, mean age: 44.8 years) comprising 474 N1a (42%), 513 N1b-CL (45%), and 151 N1b-Skip (13%). The median follow-up was 74 months (range 12-216 months). The recurrence rate in the N1b-Skip group was 13% (20/151) and 10% (47/474) in the N1a group. This was significantly lower than that in the N1b-CL group (27%, 140/513) (p < 0.0001). DSS at 10 years was 99% for group N1a, 98% for the N1b-CL, and 99% in the N1b-Skip group.
The recurrence rate of N1b-Skip patients was lower than that of N1b-CL patients and similar to that of N1a patients. This result could be used as an indication for the modality of radioiodine therapy, and for the pattern of follow-up procedures.
淋巴结转移（N1）是甲状腺乳头状癌（PTC）患者疾病复发的预后因素。跳跃转移定义为仅存在侧方 N1 而中央淋巴结（LNs）阴性。
本研究旨在探讨 PTC 患者跳跃性 N1 的结局。
本研究纳入了自 1999 年至 2019 年在一个高容量内分泌外科中心接受全甲状腺切除术加同侧中央和侧方淋巴结清扫术治疗 PTC 的所有患者。
比较三组患者的临床病理特征和结局复发率和疾病特异性生存率（DSS）：N1a（仅中央 N1）、N1b-CL（中央和侧方 N1）和 N1b-Skip（无中央 LN 累及的侧方 N1）。
在研究期间，共有 3046 例患者接受了 PTC 手术，其中 1138 例存在 N1（37%，860 例为女性，平均年龄：44.8 岁），包括 474 例 N1a（42%）、513 例 N1b-CL（45%）和 151 例 N1b-Skip（13%）。中位随访时间为 74 个月（范围 12-216 个月）。N1b-Skip 组的复发率为 13%（20/151），N1a 组为 10%（47/474）。这显著低于 N1b-CL 组（27%，140/513）（p<0.0001）。N1a、N1b-CL 和 N1b-Skip 组的 10 年 DSS 分别为 99%、98%和 99%。
N1b-Skip 患者的复发率低于 N1b-CL 患者，与 N1a 患者相似。该结果可作为放射性碘治疗方式的适应证，以及随访方案的选择依据。
