Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuan Nanli, Chaoyang District, Beijing, 100021, People's Republic of China.
BMC Cancer. 2022 Dec 1;22(1):1246. doi: 10.1186/s12885-022-10326-8.
Lateral neck is not recommended for dissection in patients with pN1a papillary thyroid cancer (PTC), but its recurrence risk has not been well stratified. We aimed to develop a risk stratification system for lateral neck recurrence in patients with pN1a PTC.
Patients with pN1a PTC who underwent thyroidectomy and unilateral central compartment dissection from 2000-2016 were enrolled. The association between number of central lymph node metastases (CLNMs) and lateral neck recurrence was comprehensively assessed using a Cox proportional hazards model with restricted cubic spline. Stratification was then performed based on CLNMs and other significant risk factors selected by multivariate analysis. Lateral neck recurrent-free survival (LRFS) rate of each stratification was estimated with Kaplan-Meier curve and comparison was performed using log-rank test.
Ninety-six (3.8%) lateral neck recurrences were identified during a median follow-up of 62 months among a total of 2500 admitted cases. An increasing number of CLNMs was associated with compromised LRFS for up to 6 CLNMs (P < 0.001), and CLNMs > 3 indicated significantly worse 5-year LRFS than that of CLNM ≤ 3 (90.6% vs. 98.1%, P < 0.001). When stratification with CLNMs and primary tumor size (selected by multivariate analysis, HR (95%CI) = 4.225(2.460-7.256), P < 0.001), 5-year LRFS rates of high- (CLNMs > 3 and primary tumor size > 2 cm), intermediate- (CLNMs > 3 and primary tumor size 1-2 cm) and low-risk (primary tumor size ≤ 1 cm or CLNMs ≤ 3) groups were 78.5%, 90.0% and 97.9%, respectively (P < 0.05).
The number of CLNMs combined with primary tumor size seems to effectively stratify lateral neck recurrence risk for patients with pN1a PTC.
不建议在 pN1a 甲状腺乳头状癌（PTC）患者中对侧颈部进行解剖，但尚未对其复发风险进行很好的分层。我们旨在为 pN1a PTC 患者的侧颈部复发建立一种风险分层系统。
纳入 2000 年至 2016 年间行甲状腺切除术和单侧中央区淋巴结清扫术的 pN1a PTC 患者。采用 Cox 比例风险模型与限制性立方样条综合评估中央淋巴结转移（CLNM）数量与侧颈部复发的关系。然后根据 CLNM 和多因素分析选择的其他显著危险因素进行分层。通过 Kaplan-Meier 曲线估计每个分层的侧颈部无复发生存率（LRFS），并使用对数秩检验进行比较。
在 2500 例入组病例中，中位随访 62 个月期间共发现 96 例（3.8%）侧颈部复发。CLNM 数量的增加与 LRFS 受损有关，多达 6 个 CLNM（P<0.001），CLNM>3 与 CLNM≤3 的 5 年 LRFS 显著较差（90.6%比 98.1%，P<0.001）。当与 CLNM 和原发肿瘤大小分层（多因素分析选择，HR（95%CI）=4.225（2.460-7.256），P<0.001）时，高风险（CLNM>3 且原发肿瘤大小>2cm）、中风险（CLNM>3 且原发肿瘤大小为 1-2cm）和低风险（原发肿瘤大小≤1cm 或 CLNM≤3）组的 5 年 LRFS 率分别为 78.5%、90.0%和 97.9%（P<0.05）。
CLNM 数量结合原发肿瘤大小似乎可以有效地分层 pN1a PTC 患者的侧颈部复发风险。
