Department of Surgical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Community Health Service Center, Jingjiang Street, Xiaoshan District, Hangzhou, China.
Endocrine. 2024 Feb;83(2):414-421. doi: 10.1007/s12020-023-03486-5. Epub 2023 Aug 18.
To investigate the impact of lateral lymph node metastasis in papillary thyroid microcarcinoma (PTMC).
5241 PTMC patients with follow-up information were enrolled in the current study. These patients underwent primary surgery in our situation from January 1997 to December 2016. Additionally, a validation cohort consisting of 274 PTMC patients who underwent primary surgery between January 2020 and December 2021 was also included. Univariable and multivariate logistic analyses were conducted to identify the association between clinicopathologic features and lateral lymph node metastasis (LLNM). Kaplan-Meier survival curve analysis was used to calculate the disease-free survival (DFS) rate. The fitting curve was generated to identify the quantitative relationship between central lymph node metastases (CLNM) and LLNM.
Of 5241 PTMC patients, cervical lymph node metastasis was detected in 1494 (28.5%) cases, including 1364 (26.0%) with CLNM only and 130 (2.5%) with LLNM. With a median follow-up time of 60 months (interquartile range [IQR], 44-81), recurrence was detected in 114 patients (2.2%). Multivariate Cox regression analyses showed that LNM was the only independent risk factor for recurrence, with HR values of 3.03 in CLNM and 11.14 in LLNM, respectively. Tumor diameter >0.5 cm (hazard ratio [HR]:1.80), multifocality (HR:2.59), bilaterality (HR:2.13), extrathyroidal invasion (HR:2.13), and CLNM (HR:5.11) were independent risk factors for LLNM. The prevalence of LLNM escalated significantly with increasing number of lymph node involvement in CLNM when stratified by the number of metastatic lymph nodes and trend was observed similarly in the validation cohort. The fitting curve showed that the incidence of LLNM could be as high as 20.7% when the number of CLNM ≥ 5.
By analyzing a large database with follow-up information, our study provides evidence that LLNM is significantly correlated with tumor recurrence in patients with PTMC. Tumor size (>0.5 cm), multifocality, bilaterality, extrathyroidal extension (ETE) and CLNM are independent risk factors for LLNM.
探讨甲状腺微小乳头状癌（PTMC）侧颈部淋巴结转移的影响。
本研究纳入了 5241 例具有随访信息的 PTMC 患者。这些患者于 1997 年 1 月至 2016 年 12 月在我院接受了初次手术治疗。此外，还纳入了 2020 年 1 月至 2021 年 12 月期间接受初次手术的 274 例 PTMC 患者的验证队列。采用单变量和多变量逻辑分析来确定临床病理特征与侧颈部淋巴结转移（LLNM）之间的关系。采用 Kaplan-Meier 生存曲线分析计算无病生存率（DFS）。绘制拟合曲线以确定中央颈部淋巴结转移（CLNM）与 LLNM 的定量关系。
在 5241 例 PTMC 患者中，1494 例（28.5%）患者颈部淋巴结转移，其中 1364 例（26.0%）仅为 CLNM，130 例（2.5%）为 LLNM。中位随访时间为 60 个月（四分位距 [IQR]，44-81），114 例患者复发（2.2%）。多变量 Cox 回归分析显示，LNM 是复发的唯一独立危险因素，CLNM 的 HR 值为 3.03，LLNM 的 HR 值为 11.14。肿瘤直径>0.5cm（危险比 [HR]：1.80）、多灶性（HR：2.59）、双侧性（HR：2.13）、甲状腺外侵犯（HR：2.13）和 CLNM（HR：5.11）是 LLNM 的独立危险因素。当按转移淋巴结数分层时，随着 CLNM 中淋巴结受累数的增加，LLNM 的发生率显著升高，在验证队列中也观察到了类似的趋势。拟合曲线显示，当 CLNM≥5 时，LLNM 的发生率可高达 20.7%。
通过分析具有随访信息的大型数据库，本研究提供了证据表明，LLNM 与 PTMC 患者的肿瘤复发显著相关。肿瘤大小（>0.5cm）、多灶性、双侧性、甲状腺外侵犯（ETE）和 CLNM 是 LLNM 的独立危险因素。
