偶发性淋巴结转移作为甲状腺乳头状癌患者无病生存期较差的独立因素
Incidental Node Metastasis as an Independent Factor of Worse Disease-Free Survival in Patients with Papillary Thyroid Carcinoma.
作者信息
Pinheiro Renan Aguera, Leite Ana Kober, Cavalheiro Beatriz Godoi, de Mello Evandro Sobroza, Kowalski Luiz Paulo, Matos Leandro Luongo
机构信息
Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil.
Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo 05653-120, Brazil.
出版信息
Cancers (Basel). 2023 Feb 2;15(3):943. doi: 10.3390/cancers15030943.
INTRODUCTION
Papillary thyroid carcinoma (PTC) have high node metastasis rates. Occasionally after thyroidectomy, the pathological report reveals node metastasis unintentionally resected. The present study aimed to evaluate the prognosis of these patients.
METHODS
A retrospective cohort of patients submitted to thyroidectomy with or without central compartment neck dissection (CCND) due to PTC with a minimum follow-up of five years.
RESULTS
A total of 698 patients were included: 320 Nx, 264 pN0-incidental, 37 pN1a-incidental, 32 pN0-CCND and 45 pN1a-CCND. Patients with node metastasis were younger, had larger tumors, higher rates of microscopic extra-thyroidal extension, and angiolymphatic invasion and most received radioiodine therapy. Treatment failure was higher in patients pN1a-incidental and pN1a-CCND (32% and 16%, respectively; < 0.001-Chi-square test). Disease-free survival (DFS) was lower in patients pN1a-incidental compared to patients Nx and pN0-incidental ( < 0.001 vs. Nx and pN0-incidental and = 0.005 vs. pN0-CCND) but similar when compared to patients pN1a-CCND ( = 0.091)-Log-Rank test. Multivariate analysis demonstrated as independent risk factors: pT4a (HR = 5.524; 95%CI: 1.380-22.113; = 0.016), pN1a-incidental (HR = 3.691; 95%CI: 1.556-8.755; = 0.003), microscopic extra-thyroidal extension (HR = 2.560; 95%CI: 1.303-5.030; = 0.006) and angiolymphatic invasion (HR = 2.240; 95%CI: 1.077-4.510; = 0.030).
CONCLUSION
Patients that were pN1a-incidental were independently associated with lower DFS.
引言
甲状腺乳头状癌（PTC）具有较高的淋巴结转移率。偶尔在甲状腺切除术后，病理报告显示意外切除了有淋巴结转移的组织。本研究旨在评估这些患者的预后。
方法
一项回顾性队列研究，纳入因PTC接受甲状腺切除术且无论是否进行中央区颈清扫术（CCND）的患者，最短随访时间为5年。
结果
共纳入698例患者：320例Nx，264例pN0-意外转移，37例pN1a-意外转移，32例pN0-CCND和45例pN1a-CCND。有淋巴结转移的患者更年轻，肿瘤更大，微小甲状腺外侵犯、血管淋巴管侵犯发生率更高，且大多数接受了放射性碘治疗。pN1a-意外转移和pN1a-CCND患者的治疗失败率更高（分别为32%和16%；卡方检验，P<0.001）。与Nx和pN0-意外转移患者相比，pN1a-意外转移患者的无病生存期（DFS）更低（与Nx和pN0-意外转移患者相比，P<0.001；与pN0-CCND患者相比，P=0.005），但与pN1a-CCND患者相比相似（P=0.091）-对数秩检验。多因素分析显示独立危险因素为：pT4a（HR=5.524；95%CI：1.380-22.113；P=0.016），pN1a-意外转移（HR=3.691；95%CI：1.556-8.755；P=0.003），微小甲状腺外侵犯（HR=2.560；95%CI：1.303-5.030；P=0.006）和血管淋巴管侵犯（HR=2.240；95%CI：1.077-4.510；P=0.030）。
结论
pN1a-意外转移的患者独立地与较低的DFS相关。
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