预防性颈侧区清扫术治疗甲状腺髓样癌的生存结局：一项回顾性队列研究。

The survival outcomes of prophylactic lateral neck dissection for medullary thyroid carcinoma, a retrospective cohort study.

机构信息

Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300040, China.

Department of Head and Neck Oncology, Tianjin Cancer Hospital Airport Hospital, Tianjin, 300308, China.

出版信息

Clin Otolaryngol. 2023 Sep;48(5):734-739. doi: 10.1111/coa.14053. Epub 2023 Jun 27.

DOI:10.1111/coa.14053

PMID:37366234

Abstract

OBJECTIVES

The purpose of this study was to evaluate the benefits of prophylactic lymph node dissection in medullary thyroid carcinoma (MTC) patients without radiographically lateral neck metastases.

DESIGN

Retrospective cohort study.

SETTING

Tianjin Medical University Cancer Institute and Hospital.

PARTICIPANTS

Patients who underwent primary surgery for MTC between 2011 and 2019 and without structural disease of the lateral neck preoperatively.

MAIN OUTCOME MEASURES

Locoregional recurrence, disease-free survival (DFS), and overall survival (OS) were examined.

RESULTS

The patients were divided into two groups: the central lymph node dissection (CLND) only group and the prophylactic lateral lymph node dissection (PLND) group, which included CLND and ipsilateral lateral lymph node dissection (LLND). A total of 89 patients were included: 71 patients in the CLND group and 18 patients in the PLND group. Although there were no significant differences in age, gender, multifocality, capsule invasion or TNM stage between the two groups, the tumour size and preoperative median calcitonin levels were different. The recurrence rate was 4.2% for the CLND group and 5.6% for the PLND group (p > 0.05). DFS among the CLND and PLND groups was 95.4% and 94.4%, and OS among the groups was 100% and 94.1% (p > 0.05) at 5 years. The biochemical cure rates were similar.

CONCLUSIONS

PLND in the absence of structural disease of the lateral neck preoperatively is not associated with improved survival in patients with sporadic MTC.

摘要

目的

本研究旨在评估预防性淋巴结清扫术对无影像学侧颈部转移的甲状腺髓样癌（MTC）患者的益处。

设计

回顾性队列研究。

地点

天津医科大学肿瘤医院。

参与者

2011 年至 2019 年期间因 MTC 接受初次手术且术前无侧颈部结构性疾病的患者。

主要观察指标

局部区域复发、无病生存率（DFS）和总生存率（OS）。

结果

患者分为中央淋巴结清扫（CLND）组和预防性侧方淋巴结清扫（PLND）组，PLND 组包括 CLND 和同侧侧方淋巴结清扫（LLND）。共纳入 89 例患者：CLND 组 71 例，PLND 组 18 例。两组间年龄、性别、多灶性、包膜侵犯或 TNM 分期无显著差异，但肿瘤大小和术前中位降钙素水平不同。CLND 组的复发率为 4.2%，PLND 组为 5.6%（p>0.05）。CLND 组和 PLND 组的 DFS 分别为 95.4%和 94.4%，OS 分别为 100%和 94.1%（p>0.05），5 年时。生化治愈率相似。