预防性中央区颈清扫术治疗 cN0 期甲状腺乳头状癌：西方国家与中国有何不同？系统评价和荟萃分析。

Prophylactic central neck dissection for cN0 papillary thyroid carcinoma: is there any difference between western countries and China? A systematic review and meta-analysis.

机构信息

Department of Breast and Thyroid Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Department of Biotherapy and National Clinical Research Center for Geriatrics, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.

出版信息

Front Endocrinol (Lausanne). 2023 Jul 27;14:1176512. doi: 10.3389/fendo.2023.1176512. eCollection 2023.

BACKGROUND

Recommendations for the performance of prophylactic central neck dissection (pCND) in patients with clinically node-uninvolved (cN0) papillary thyroid carcinoma (PTC) are not the same. This meta-analysis set out to compare the effectiveness of pCND with total thyroidectomy (TT) in different countries and regions, mainly between western countries and China.

METHODS

The electronic databases PubMed, EMBASE, and Cochrane Library were searched for studies published until August 2022. The incidence rate of cervical lymph node metastases (LNMs), locoregional recurrences (LRRs), and postoperative complications were pooled by a random-effects model. Subgroup analyses based on different countries and regions were performed.

RESULTS

Eighteen studies involving 5,346 patients were analyzed. In the subgroup of western countries, patients undergoing pCND with TT had a significantly lower LRR rate [69/1,804, 3.82% vs. 139/2,541, 5.47%; odds ratio (OR) = 0.56; 95% CI 0.37-0.85] and a higher rate of temporary hypoparathyroidism (HPT) (316/1,279, 24.71% vs. 194/1,467, 13.22%; OR = 2.23; 95% CI 1.61-3.08) than that of the TT alone group, while no statistically significant difference was found in the rate of permanent HPT and temporary and permanent recurrent laryngeal nerve (RLN) injury. In the Chinese subgroup, the pCND with TT group had a significantly higher incidence rate of both temporary HPT (87/374, 23.26% vs. 36/324, 11.11%; OR = 2.24; 95% CI 1.32-3.81) and permanent HPT (21/374, 5.61% vs. 4/324, 1.23%; OR = 3.58; 95% CI = 1.24-10.37) than that of the TT alone group, while no significant difference was detected in the rate of LRR and temporary and permanent RLN injury.

CONCLUSION

Compared with the TT alone for cN0 PTC patients, pCND with TT had a significantly lower LRR rate while having a higher temporary HPT rate in Europe, America, and Australia; however, it showed no significant difference in decreasing LRR rate while having a significantly raised rate of temporary and permanent HPT in China. More population-based results are required to advocate precision medicine in PTC.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022358546.

背景

对于临床颈部淋巴结阴性（cN0）的甲状腺乳头状癌（PTC）患者，预防性中央颈部清扫术（pCND）的建议并不相同。本荟萃分析旨在比较 pCND 与全甲状腺切除术（TT）在不同国家和地区的效果，主要是在西方国家和中国之间进行比较。

方法

检索了截至 2022 年 8 月发表的 PubMed、EMBASE 和 Cochrane 图书馆的电子数据库。通过随机效应模型对颈部淋巴结转移（LNM）、局部区域复发（LRR）和术后并发症的发生率进行了汇总。还进行了基于不同国家和地区的亚组分析。

结果

分析了 18 项涉及 5346 名患者的研究。在西方国家的亚组中，接受 pCND 联合 TT 的患者 LRR 率显著降低[69/1804，3.82%比 139/2541，5.47%；比值比（OR）=0.56；95%置信区间（CI）0.37-0.85]，暂时性甲状旁腺功能减退（HPT）的发生率更高（316/1279，24.71%比 194/1467，13.22%；OR=2.23；95%CI 1.61-3.08），而永久性 HPT 和暂时性及永久性喉返神经（RLN）损伤的发生率无统计学差异。在中国亚组中，pCND 联合 TT 组的暂时性 HPT 发生率明显更高[87/374，23.26%比 36/324，11.11%；OR=2.24；95%CI 1.32-3.81]和永久性 HPT 发生率[21/374，5.61%比 4/324，1.23%；OR=3.58；95%CI=1.24-10.37]明显高于 TT 单独组，而 LRR 和暂时性及永久性 RLN 损伤的发生率无显著差异。