Kang Il Ku, Park Joonseon, Bae Ja Seong, Kim Jeong Soo, Kim Kwangsoon
Department of Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul 05278, Republic of Korea.
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
Cancers (Basel). 2023 May 27;15(11):2947. doi: 10.3390/cancers15112947.
The American Thyroid Association risk stratification system suggests that having >5 metastatic lymph nodes (LNs) increase the recurrence risk in patients with papillary thyroid carcinoma (PTC). However, little is known about PTC with <5 harvested LNs. This study aimed to stratify patients with low-LN-yield (low-LNY) PTC based on lymph node ratios (LNRs). From 2007 to 2017, 6317 patients who underwent thyroidectomies were diagnosed with PTC at Seoul St. Mary's Hospital, and 909 patients with low LNYs were included in the study. Tumor recurrence was compared based on LNR. The LNR cutoff was determined using a receiver operating characteristic curve. Forty-six patients (5.1%) experienced recurrences over a mean follow-up period of 127.24 ± 33.6 months (range, 5-190 months). The cutoff for the low-LNR ( = 675) and high-LNR ( = 234) groups was 0.29 (AUC = 0.676, 95% CI = 0.591-0.761, < 0.001). The recurrence rate was significantly higher in the high-LNR group compared to the rate in the low-LNR group (12.4% vs. 2.5%, < 0.001). Multivariate analysis using Cox regression revealed that tumor size and LNR ≥ 0.29 were independent prognostic factors for recurrence. Therefore, LNR can be utilized to stratify the risk of recurrence in patients with low-LNY PTC.
美国甲状腺协会风险分层系统表明，转移性淋巴结（LN）>5个会增加甲状腺乳头状癌（PTC）患者的复发风险。然而，对于清扫出的LN<5个的PTC患者，我们知之甚少。本研究旨在基于淋巴结比率（LNR）对低淋巴结收获量（低LNY）的PTC患者进行分层。2007年至2017年，在首尔圣玛丽医院，6317例行甲状腺切除术的患者被诊断为PTC，其中909例低LNY患者被纳入研究。根据LNR比较肿瘤复发情况。使用受试者工作特征曲线确定LNR临界值。46例患者（5.1%）在平均127.24±33.6个月（范围5 - 190个月）的随访期内出现复发。低LNR（n = 675）组和高LNR（n = 234）组的临界值为0.29（AUC = 0.676，95%CI = 0.591 - 0.761，P<0.001）。高LNR组的复发率显著高于低LNR组（12.4%对2.5%，P<0.001）。使用Cox回归进行多因素分析显示，肿瘤大小和LNR≥0.29是复发的独立预后因素。因此，LNR可用于对低LNY的PTC患者的复发风险进行分层。
