Xiao Xiangyuqin, Wu Yaqin, Zou Lianhong, Chen Yiru, Zhang Chaojie
Department of Breast and Thyroid Surgery, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China.
Institute for Translational Medicine, The First Affiliated Hospital of Hunan Normal University/Hunan Provincial People's Hospital, Changsha, China.
Gland Surg. 2022 Jul;11(7):1204-1211. doi: 10.21037/gs-22-337.
Tumor metastasis to lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) is a main cause of disease recurrence in patients with papillary thyroid carcinoma (PTC), which may increase the risk of recurrence and secondary surgery, and the disruption of normal anatomical relationships during secondary surgery increases the risk of laryngeal nerve injury and hypoparathyroidism. However, controversy remains as to whether the dissection of LN-prRLN is required in cN PTC patients. The purpose of this study is to explore the factors associated with LN-prRLN metastasis in patients with cN PTC and the need for LN-prRLN node dissection in patients with cN PTC who undergo right central compartment dissection.
The clinical data of 290 patients with cN PTC who received radical thyroid cancer surgery from December 2019 to March 2022 at our center were retrospectively analyzed. All the patients underwent thyroid lobectomy and right central lymph node dissection (CLND), along with other treatments. SPSS 26.0 statistical software was used for the analysis. The measurement data were compared using the rank-sum test, and the count data were compared using the chi-square test.
LN-prRLN metastasis was detected in 65 (22.4%) of the 290 cN PTC patients. The metastasis sites included level VIa (51.72%), the left central compartment (22.76%), and the prelaryngeal compartment (8.97%). The univariate analysis revealed that tumor multifocality, a tumor diameter >1 cm, capsular invasion, LN metastasis in the left central compartment, and level VIa positivity were influencing factors of LN-prRLN metastasis in PTC patients. The logistic regression analysis showed that a tumor diameter >1 cm (OR =2.897, 95% CI: 1.630-5.147, P<0.001), LN metastasis in the left central compartment (OR =3.724, 95% CI: 2.039-6.801, P<0.001), and level VIa (OR =3.405, 95% CI: 1.846-6.281, P<0.001) positivity were independent risk factors of LN-prRLN metastasis in PTC patients.
The high-risk factors of LN-prRLN metastasis in cN PTC patients include a large tumor (a diameter >1 cm), lymph node metastasis in the left central compartment, and lymph node metastasis in level VIa. For patients with cN PTC undergoing right CLND, with high-risk factors of LN-prRLN metastasis, LN-prRLN dissection is recommended.
Papillary thyroid carcinoma (PTC); lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN); central compartment lymph node dissection; risk factor.
甲状腺乳头状癌（PTC）患者中，肿瘤转移至右喉返神经后方淋巴结（LN-prRLN）是疾病复发的主要原因，这可能增加复发风险及二次手术的几率，且二次手术时正常解剖关系的破坏会增加喉返神经损伤及甲状旁腺功能减退的风险。然而，对于临床N0（cN）期PTC患者是否需要清扫LN-prRLN仍存在争议。本研究旨在探讨cN期PTC患者中与LN-prRLN转移相关的因素，以及接受右侧中央区淋巴结清扫术的cN期PTC患者是否需要进行LN-prRLN淋巴结清扫。
回顾性分析2019年12月至2022年3月在我院中心接受甲状腺癌根治术的290例cN期PTC患者的临床资料。所有患者均接受甲状腺叶切除术及右侧中央区淋巴结清扫术（CLND），并接受了其他治疗。使用SPSS 26.0统计软件进行分析。计量资料采用秩和检验比较，计数资料采用卡方检验比较。
290例cN期PTC患者中，65例（22.4%）检测到LN-prRLN转移。转移部位包括Ⅵa区（51.72%）、左侧中央区（22.76%）和喉前区（8.97%）。单因素分析显示，肿瘤多灶性、肿瘤直径>1 cm、包膜侵犯、左侧中央区淋巴结转移及Ⅵa区阳性是PTC患者LN-prRLN转移的影响因素。Logistic回归分析显示，肿瘤直径>1 cm（OR =2.897，95%CI：1.630 - 5.147，P<0.001）、左侧中央区淋巴结转移（OR =3.724，95%CI：2.039 - 6.801，P<0.001）及Ⅵa区阳性（OR =3.405，95%CI：1.846 - 6.281, P<0.001）是PTC患者LN-prRLN转移的独立危险因素。
cN期PTC患者LN-prRLN转移的高危因素包括肿瘤较大（直径>1 cm）、左侧中央区淋巴结转移及Ⅵa区淋巴结转移。对于接受右侧CLND且具有LN-prRLN转移高危因素的cN期PTC患者，建议进行LN-prRLN清扫。
甲状腺乳头状癌（PTC）；右喉返神经后方淋巴结（LN-prRLN）；中央区淋巴结清扫；危险因素
