N odal 因素协同作用预测 N1b 期甲状腺乳头状癌治疗后复发。

Synergy of Nodal Factors in Predicting Recurrence After Treatment of N1b Papillary Thyroid Carcinoma.

机构信息

Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.

Department of Otolaryngology Head and Neck Surgery, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.

出版信息

J Clin Endocrinol Metab. 2024 Nov 18;109(12):3137-3145. doi: 10.1210/clinem/dgae329.

DOI:10.1210/clinem/dgae329

PMID:38748619

Abstract

BACKGROUND

Nodal factors are important predictors of prognosis for papillary thyroid carcinoma (PTC), but their synergistic effect is not well understood. We aimed to explore their synergy in predicting recurrence of clinical N1b (cN1b) PTC.

METHODS

Patients who underwent surgery for cN1b PTC from 2013 to 2017 were enrolled. The association between nodal factors and recurrence was assessed using Cox proportional hazards regression models. Interaction and stratified analyses were conducted according to significant nodal factors.

RESULTS

Of 1067 cN1b PTC patients included, all nodal factors (bilateral metastasis, largest dimension > 3 cm, micro and gross extranodal extension (mENE, gENE), number of metastatic lymph nodes [MLN], lymph node yield [LNY], and ratio LNR]) were significantly associated with all site and nodal recurrence in the univariate analysis (all P < .05). Multivariate analyses revealed largest dimension > 3 cm, gENE and LNR > 0.21 were associated with elevated both all site (hazard ratio [HR] [95% CI], 2.58 [1.67-4.00], 1.87 [1.26-3.01], 1.68 [1.11-2.42], all P < .01) and nodal recurrences (HR [95% CI], 2.63 [1.67-4.13], 1.90 [1.15-3.12], 1.76 [1.17-2.66], all P < .01). LNR and gENE had interactive effect (all site recurrence: P for interaction = .009; nodal recurrence: P for interaction = .02). LNR was significantly associated with recurrence in patients without gENE (HR [95% CI], all site recurrence: 2.41 [1.50-3.87]; nodal recurrence: 2.51 [1.52-4.14], all P < .001), while when gENE appeared, LNR was no longer associated with recurrence (HR [95% CI], all site recurrence: 0.81 [0.43-1.54], P = .53; nodal recurrence: 0.85 [0.43-1.67], P = .64).

CONCLUSION

Nodal factors have synergistic effect in predicting recurrence in cN1b PTC patients. Increasing lymph nodes harvest may only decrease recurrence in patients without gENE, while not in gENE patients.

摘要

背景

淋巴结因素是预测甲状腺乳头状癌（PTC）预后的重要指标，但它们的协同作用尚不清楚。我们旨在探讨其在预测临床 N1b（cN1b）PTC 复发中的协同作用。

方法

纳入 2013 年至 2017 年因 cN1b PTC 接受手术治疗的患者。采用 Cox 比例风险回归模型评估淋巴结因素与复发的关系。根据显著的淋巴结因素进行交互和分层分析。

结果

在 1067 例 cN1b PTC 患者中，所有淋巴结因素（双侧转移、最大直径>3cm、微小和大体淋巴结外扩展（mENE、gENE）、转移淋巴结数目[MLN]、淋巴结检出率[LNY]和淋巴结比值 LNR）在单因素分析中均与所有部位和淋巴结复发显著相关（均 P<0.05）。多因素分析显示，最大直径>3cm、gENE 和 LNR>0.21 与所有部位（危险比[HR] [95%CI]，2.58 [1.67-4.00]、1.87 [1.26-3.01]、1.68 [1.11-2.42]，均 P<0.01）和淋巴结复发（HR [95%CI]，2.63 [1.67-4.13]、1.90 [1.15-3.12]、1.76 [1.17-2.66]，均 P<0.01）相关。LNR 和 gENE 具有交互作用（所有部位复发：P 交互值=0.009；淋巴结复发：P 交互值=0.02）。LNR 与无 gENE 的患者的复发显著相关（HR [95%CI]，所有部位复发：2.41 [1.50-3.87]；淋巴结复发：2.51 [1.52-4.14]，均 P<0.001），而当出现 gENE 时，LNR 与复发不再相关（HR [95%CI]，所有部位复发：0.81 [0.43-1.54]，P=0.53；淋巴结复发：0.85 [0.43-1.67]，P=0.64）。