Liu Qiang, Pang Wen-Ting, Dong Yan-Bo, Wang Zhen-Xiao, Yu Ming-Hang, Huang Xue-Feng, Liu Liang-Fa
Department of Otolaryngology Head and Neck Surgery, Beijing Friendship Hospital Capital Medical University Beijing China.
Department of Otolaryngology The TCM Hospital Affiliated to Southwest Medical University Luzhou Sichuan China.
World J Otorhinolaryngol Head Neck Surg. 2022 Apr 18;8(3):274-278. doi: 10.1016/j.wjorl.2021.01.002. eCollection 2022 Sep.
To investigate the risk factors for lateral lymph node metastasis (LLNM) in papillary thyroid carcinoma (PTC).
A retrospective analysis of 209 patients with PTC who underwent primary surgery at the Beijing Friendship Hospital affiliated with Capital Medical University from November 2014 to November 2018 was performed. The patients were divided into the LLNM group and the non-LLNM group. The clinical and pathological characteristics of the patients were analysed. The risk factors for LLNM were analysed by univariate and multivariate analyses.
The incidence of LLNM was 13.4% in PTC patients. Univariate analysis showed that the maximum diameter of the primary tumour > 2 cm ( < 0.001), bilateral primary tumour ( = 0.020), extrathyroidal extension (ETE) ( < 0.001), central lymph node metastasis (CLNM) ( < 0.001), and CLNM number ≥ 5 ( < 0.001) were significantly associated with LLNM. Multivariate logistic regression analysis showed that the maximum diameter of the primary tumour > 2 cm, ETE, and CLNM were independent risk factors for LLNM ( values were 3.880, 5.202, and 4.474, respectively). There were 6 patients with skip lateral cervical lymph node metastasis, accounting for 21% of all LLNM patients.
This study revealed several independent risk factors for predicting LLNM in PTC patients, such as the maximum diameter of the primary tumour > 2 cm, ETE and CLNM. Lateral neck dissection may be recommended in PTC patients with those risk factors. Paying attention to the occurrence of skip lateral cervical lymph node metastasis during the clinical diagnosis and treatment processes is necessary.
探讨甲状腺乳头状癌（PTC）侧方淋巴结转移（LLNM）的危险因素。
对2014年11月至2018年11月在首都医科大学附属北京友谊医院接受初次手术的209例PTC患者进行回顾性分析。将患者分为LLNM组和非LLNM组。分析患者的临床和病理特征。通过单因素和多因素分析LLNM的危险因素。
PTC患者中LLNM的发生率为13.4%。单因素分析显示，原发肿瘤最大径>2 cm（<0.001）、双侧原发肿瘤（=0.020）、甲状腺外侵犯（ETE）（<0.001）、中央区淋巴结转移（CLNM）（<0.001）以及CLNM数量≥5个（<0.001）与LLNM显著相关。多因素logistic回归分析显示，原发肿瘤最大径>2 cm、ETE和CLNM是LLNM的独立危险因素（其值分别为3.880、5.202和4.474）。有6例患者出现跳跃性侧颈淋巴结转移，占所有LLNM患者的21%。
本研究揭示了PTC患者预测LLNM的几个独立危险因素，如原发肿瘤最大径>2 cm、ETE和CLNM。对于具有这些危险因素的PTC患者，可能建议行侧颈淋巴结清扫术。在临床诊疗过程中，有必要关注跳跃性侧颈淋巴结转移的发生情况。
