Department of Anesthesiology, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, P.R. China.
Department of Thyroid Breast Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang, P.R. China.
Medicine (Baltimore). 2023 Sep 8;102(36):e35045. doi: 10.1097/MD.0000000000035045.
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer, and surgery is crucial for curing PTC. PTC patients often experience lymph node metastasis (LNM) in the neck, and central lymph node metastasis (CLNM) significantly affects the recurrence rate of PTC. Therefore, the thoroughness of the surgery is particularly important for the treatment of PTC. However, there is still controversy regarding the choice of surgical approach. This study retrospectively analyzed the clinical data of 69 PTC patients treated at our hospital from December 2019 to April 2022 and clinically analyzed the high-risk factors for neck LNM. In this study, the patients aged ≤ 55 years were examined in which the number of patients with CLNM were 42 cases (80.77%), tumor diameter >2 cm were 15 cases (100%), the multifocal carcinoma were 38 cases (88.37%) and the involvement of membrane were 38 cases (80.85%), the number of patients whose had lateral cervical lymph node metastasis (LLNM), respectively 43 cases (82.69%), 14 cases (93.33%), 39 cases (90.7%) and 40 cases (85.11%),all of these factors were associated with cervical LNM (P < .05), but was not correlation with sex, double lobe carcinoma, extra glandular invasion and hashimoto (P > .05). The patient's age and number of cancers were independent risk factors for LNM in the central region of the neck (P < .05), while the patient's age, tumor size and number of cancers were significant risk factors for LNM in the lateral cervical region (P < .05). We concluded that cervical LNM was related with the high-risk factors of patient's age, tumor size, multifocal carcinoma in PTC. Especially, modified radical cervical dissection or selective cervical dissection was suggested in the PTC patients who were younger than 42.5 years old, with tumor diameter larger than 2 cm and multifocal carcinoma.
甲状腺乳头状癌（PTC）是最常见的甲状腺癌类型，手术是治愈 PTC 的关键。PTC 患者常发生颈部淋巴结转移（LNM），中央区淋巴结转移（CLNM）显著影响 PTC 的复发率。因此，手术的彻底性对于 PTC 的治疗尤为重要。然而，手术方式的选择仍存在争议。本研究回顾性分析了 2019 年 12 月至 2022 年 4 月我院收治的 69 例 PTC 患者的临床资料，并对颈部 LNM 的高危因素进行临床分析。本研究中，对年龄≤55 岁的患者进行检查，其中 CLNM 患者 42 例（80.77%），肿瘤直径>2cm 患者 15 例（100%），多灶癌患者 38 例（88.37%），膜受累患者 38 例（80.85%），侧颈淋巴结转移（LLNM）患者分别为 43 例（82.69%）、14 例（93.33%）、39 例（90.7%）和 40 例（85.11%），这些因素均与颈部 LNM 相关（P<.05），但与性别、双叶癌、腺外侵犯和桥本无关（P>.05）。患者年龄和癌数是中央区 LNM 的独立危险因素（P<.05），而患者年龄、肿瘤大小和癌数是侧颈区 LNM 的显著危险因素（P<.05）。我们得出结论，PTC 患者的年龄、肿瘤大小、多灶癌与颈部 LNM 有关。特别是对于年龄小于 42.5 岁、肿瘤直径大于 2cm、多灶癌的 PTC 患者，建议行改良根治性颈清扫术或选择性颈清扫术。
