Qin Chao, Cai Sijia, Yin Min, Ma Ben, Shen Cenkai, Zhang Yanzhi, Ji Qinghai, Liao Tian, Wang Yu
Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200000, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200000, China.
J Endocr Soc. 2024 Jul 5;8(8):bvae131. doi: 10.1210/jendso/bvae131. eCollection 2024 Jul 1.
The incidence of lymph node metastasis in papillary thyroid carcinoma (PTC) is common and a significant risk factor for local recurrence; however, its impact on recurrence patterns among low-risk patients remains uncertain. We aimed to elucidate the effect of metastatic lymph node on recurrence type. The medical records of 1209 patients with stage T1 PTC who underwent unilateral thyroidectomy with ipsilateral central lymph node dissection were retrospectively analyzed. The study first identified risk factors for different types of recurrence and then categorized patients as high or low risk based on their lymph node positive ratio (LNPR). The diagnostic accuracy of LNPR in predicting recurrence was compared using receiver operating characteristic (ROC) curve analysis, while differences in recurrence-free survival were assessed using the Kaplan-Meier method. During follow-up, a total of 502 (41.5%) patients had central lymph node metastasis and 52 (4.3%) patients experienced recurrence. Notably, LNPR was significantly higher in relapsed patients compared to nonrelapsed patients, with mean values of 0.45 and 0.23, respectively ( < .001). The recurrence rate of residual thyroid did not differ significantly across different T stages ( = .679), N stages ( = .415), or LNPR risk groups ( = .175). However, the recurrence rate of lymph nodes showed a significant correlation with LNPR ( < .001). The area under the ROC curves for LNPR risk stratification at 5 and 10 years were approximately 0.691 and 0.634, respectively, both of which outperformed N stage. The findings underscore the significance of LNPR's reliability as a prognostic indicator for local lymph node recurrence in patients diagnosed with T1 stage PTC.
甲状腺乳头状癌（PTC）中淋巴结转移的发生率很常见，是局部复发的一个重要危险因素；然而，其对低风险患者复发模式的影响仍不确定。我们旨在阐明转移性淋巴结对复发类型的影响。回顾性分析了1209例接受单侧甲状腺切除术并同侧中央区淋巴结清扫的T1期PTC患者的病历。该研究首先确定了不同类型复发的危险因素，然后根据患者的淋巴结阳性率（LNPR）将其分为高风险或低风险。使用受试者工作特征（ROC）曲线分析比较LNPR预测复发的诊断准确性，同时使用Kaplan-Meier方法评估无复发生存率的差异。在随访期间，共有502例（41.5%）患者发生中央区淋巴结转移，52例（4.3%）患者出现复发。值得注意的是，复发患者的LNPR显著高于未复发患者，平均值分别为0.45和0.23（<.001）。残留甲状腺的复发率在不同的T分期（=.679）、N分期（=.415）或LNPR风险组（=.175）之间没有显著差异。然而，淋巴结的复发率与LNPR显著相关（<.001）。LNPR风险分层在5年和10年时的ROC曲线下面积分别约为0.691和0.634，均优于N分期。这些发现强调了LNPR作为T1期PTC患者局部淋巴结复发预后指标的可靠性的重要性。
