Division of Endocrinology, Hospital de Clínicas, University of Buenos Aires, Buenos Aires, Argentina.
Thyroid. 2022 Oct;32(10):1178-1183. doi: 10.1089/thy.2022.0302. Epub 2022 Sep 6.
It has been suggested that small metastatic lymph nodes (LNs) detected after initial surgery in patients with differentiated thyroid cancer (DTC) can be managed with active surveillance (AS). However, there is still concern regarding the clinical outcomes of these patients. The main aims of our study were as follows: (1) to assess the frequency of growth and the need of additional treatment in a group of patients with LN recurrences selected for AS, and (2) to determine predictive factors of LN progression. We retrospectively reviewed 856 clinical records from our DTC patient's database (May 2010 to January 2022). Eighty patients had suspicious cervical LNs on consecutive ultrasound (US) after initial surgery, but we included 50 patients with cytological confirmation of metastatic disease and at least 12 months follow-up. Exclusion criteria were as follows: any LN ≥2 cm or multiple LNs ≥1.5 cm in size, proximity to vital structures, PET-positive disease (standard uptake value ≥5), aggressive histology, and distant metastasis. Patients were followed with thyroglobulin (Tg) and thyroglobulin antibodies measurements on suppressive therapy and neck US every 6-12 months. LN growth was defined as an increase of ≥3 mm in any of its diameters. A total of 50 patients had a median age of 41 years (range, 18-75). Most patients were women (80%) and had classical papillary thyroid cancer (86%). The mean size of the LNs was 10.1 ± 4.4 mm. After a median follow-up of 29 months (range, 12-144), 12 patients (24%) had an increase in size of the metastatic LN, 7 (58%) of whom were surgically removed. None of these seven patients had a structural incomplete response at the end of follow-up. The only variable that predicted an increase in LN size was a rise in Tg levels ≥0.5 ng/mL ( = 0.016). Based on a multivariate analysis, patients with increase in Tg levels ≥0.5 ng/mL had a significantly higher chance of developing LN growth (odds ratio [OR] 16.2 [confidence interval, CI 1.5-120.2], = 0.020). The median progression-free survival rate was 6.6 years [CI 5.6-9.5]. AS of small LNs could be a feasible alternative to immediate surgery in properly selected patients.
有人提出，对于分化型甲状腺癌（DTC）患者初始手术后检测到的小转移性淋巴结（LNs），可以采用主动监测（AS）进行管理。然而，人们仍然对这些患者的临床结局存在担忧。我们的研究主要目的如下：（1）评估一组选择 AS 的 LN 复发患者的淋巴结生长频率和额外治疗需求；（2）确定 LN 进展的预测因素。我们回顾性分析了 2010 年 5 月至 2022 年 1 月期间我们 DTC 患者数据库中的 856 份临床记录。80 例患者在初始手术后连续超声（US）检查中发现可疑颈部 LNs，但我们纳入了 50 例细胞学证实存在转移性疾病且至少随访 12 个月的患者。排除标准如下：任何 LN≥2cm 或多个 LN≥1.5cm 大小、临近重要结构、PET 阳性疾病（标准摄取值≥5）、侵袭性组织学和远处转移。患者接受抑制治疗并每 6-12 个月进行一次颈部 US 和甲状腺球蛋白（Tg）和甲状腺球蛋白抗体测量。LN 生长定义为任何直径增加≥3mm。共有 50 例患者的中位年龄为 41 岁（范围 18-75 岁）。大多数患者为女性（80%），患有经典型乳头状甲状腺癌（86%）。LNs 的平均大小为 10.1±4.4mm。中位随访 29 个月（范围 12-144）后，12 例（24%）患者转移性 LNs 增大，其中 7 例（58%）接受了手术切除。在随访结束时，这 7 例患者均无结构不完全反应。唯一可预测 LNs 增大的变量是 Tg 水平升高≥0.5ng/ml（ = 0.016）。基于多变量分析，Tg 水平升高≥0.5ng/ml 的患者发生 LNs 生长的几率明显更高（比值比[OR]16.2[置信区间，CI 1.5-120.2]， = 0.020）。无进展生存率中位数为 6.6 年[CI 5.6-9.5]。在适当选择的患者中，小 LNs 的 AS 可能是立即手术的可行替代方案。
