The Second Department of General Surgery, Zhongshan City People's Hospital, No. 2, Sunwen East Road, Zhongshan, Guangdong528403, China.
BMC Endocr Disord. 2023 May 29;23(1):125. doi: 10.1186/s12902-023-01375-6.
To investigate the effect of central lymph node dissection on the prognosis of patients with papillary thyroid microcarcinoma (PTMC) without clinical lymph node metastasis (cN0).
According to the inclusion and exclusion criteria, 462 patients with cN0 PTMC underwent surgery in the Second Department of General Surgery, Zhongshan City People's Hospital from January 1, 2007, to June 31, 2017. They were divided into two groups: the undissection group (262 cases) and the dissection group (170 cases). A comparison was made between the two groups in terms of postoperative complications, recurrences, metastases, etc., as well aslymph node metastasis risk factors in the central region of cN0 PTMC.
There was no lymphatic leakage or death in all patients after the operation. In the dissection group, 64 cases (37.6%) of central lymph node metastasis were found after the postoperative pathological examination. The undissection group was followed up for (92 ± 28.7) months, and the dissection group was followed up for (86 ± 25.4) months (t=-2.165, P = 0.031). In the two groups, there were no lung metastases, bone metastases, or other distant metastases during the follow-up period. In the undissection group, there were 7 cases, while in the dissection group, there were just 2. Recurrence rates between the two groups did not differ significantly (χ = 0.126, P = 0.169); Similarly, disease-free survival curves did not differ significantly (χ = 2.565, P = 0.708). Hypoparathyroidism and Hypocalcemia also had no difference between the group. In comparison to the undissection group, the capsular invasion rate (P = 0.026), calcification rate(P < 0.001) incidence of postoperative hoarseness (P = 0.017), and hand and foot numbness rate (P < 0.001) were all considerably greater in the dissection group. Multivariate research revealed that capsular invasion (OR = 9.42, P = 0.002), multifocal (OR = 24.57, P < 0.001), and tumor diameter > 5 mm (OR = 5.46, P = 0.019) were the independent risk factors for central lymph node metastasis in cN0 PTMC.
Thyroidectomy alone is safe for cN0 PTMC, but longer-term follow-up is still required for changes in central lymph nodes. For cN0 PTMC patients with tumor diameter > 5 mm, multifocal, and capsular invasion, central lymph node metastasis is more likely to occur. Comprehensive evaluation and individualized and precise treatment are essential.
为了研究中央淋巴结清扫术对无临床淋巴结转移（cN0）的甲状腺微小乳头状癌（PTMC）患者预后的影响。
根据纳入和排除标准，2007 年 1 月 1 日至 2017 年 6 月 31 日，中山市人民医院普外科二科对 462 例 cN0 PTMC 患者进行手术。他们被分为两组：未清扫组（262 例）和清扫组（170 例）。比较两组患者术后并发症、复发、转移等情况，以及 cN0 PTMC 中央区淋巴结转移的危险因素。
所有患者术后均无淋巴漏或死亡。清扫组术后病理检查发现中央淋巴结转移 64 例（37.6%）。未清扫组随访（92±28.7）个月，清扫组随访（86±25.4）个月（t=-2.165，P=0.031）。两组患者随访期间均无肺转移、骨转移或其他远处转移。未清扫组有 7 例复发，清扫组有 2 例复发。两组复发率差异无统计学意义（χ²=0.126，P=0.169）；同样，无病生存率曲线也无显著差异（χ²=2.565，P=0.708）。甲状旁腺功能减退和低钙血症两组间也无差异。与未清扫组相比，清扫组包膜侵犯率（P=0.026）、钙化率（P<0.001）、术后声音嘶哑发生率（P=0.017）和手足麻木发生率（P<0.001）均显著升高。多因素研究显示，包膜侵犯（OR=9.42，P=0.002）、多灶性（OR=24.57，P<0.001）和肿瘤直径>5mm（OR=5.46，P=0.019）是 cN0 PTMC 中央淋巴结转移的独立危险因素。
对于 cN0 PTMC，甲状腺切除术是安全的，但仍需要对中央淋巴结的变化进行长期随访。对于肿瘤直径>5mm、多灶性和包膜侵犯的 cN0 PTMC 患者，更有可能发生中央淋巴结转移。需要进行综合评估和个体化、精准化治疗。
