中央区颈清扫术后 cN1a 期甲状腺乳头状癌侧颈部淋巴结复发的危险因素及分布模式。
Risk factors and distribution pattern of lateral lymph node recurrence after central neck dissection for cN1a papillary thyroid carcinoma.
机构信息
Department of General Surgery III, Taihe Hospital, Hubei University of Medicine, 32 Renmin South Road, Shiyan, Hubei, 442000, China.
Department of General Surgery, Xiamen Humanity Hospital Fujian Medical University, 3777 Xianyue Road, Xiamen, Fujian, 361000, China.
出版信息
BMC Surg. 2024 Sep 27;24(1):270. doi: 10.1186/s12893-024-02564-3.
BACKGROUND
The indication and extent of selective lateral neck dissection (LND) for cN1a papillary thyroid carcinoma (PTC) remain uncertain. The present study aimed to identify potential predictors and distribution pattern of lateral lymph node recurrence (LLNR) after central neck dissection in cN1a PTC patients.
METHODS
The cN1a PTC patients who underwent initial central neck dissection at our centre were retrospectively reviewed, and the median follow-up period was 6.8 years. Reoperation with LND was performed when LLNR was confirmed. Risk factors for LLNR were identified, and the metastatic status of each lateral level was recorded.
RESULTS
Of the 310 patients enrolled in the present study, fifty-eight patients (18.7%) presented with LLNR. Six independent factors, including tumour diameter, pathological T4 stage, number of involved central lymph nodes, pTNM stage, extrathyroidal extension, and I treatment (P values < 0.05) were identified via multivariate analysis. LLNR was found at level II in 26 patients (44.8%), level III in 38 patients (65.5%), level IV in 30 patients (51.7%), and level V in 8 patients (13.8%). The number of positive lateral lymph nodes at levels II, III, IV and V was 44 (22.9%), 76 (39.6%), 63 (32.8%), and 9 (4.9%), respectively.
CONCLUSIONS
For cN1a PTC patients who underwent central neck dissection, tumour diameter ≥ 2 cm, pathological T4 stage, number of involved central lymph nodes ≥ 3, pTNM stage III-IV, extrathyroidal extension, and failure to receive I treatment were independent predictors of LLNR, which was more likely to occur at levels III and IV.
背景
cN1a 甲状腺乳头状癌（PTC）选择性颈侧区清扫术（LND）的适应证和范围仍不确定。本研究旨在确定 cN1a PTC 患者行中央区清扫术后颈侧区淋巴结复发（LLNR）的潜在预测因素和分布模式。
方法
回顾性分析在本中心行初次中央区清扫术的 cN1a PTC 患者，中位随访时间为 6.8 年。当确认有 LLNR 时，行 LND 再次手术。确定 LLNR 的危险因素，并记录每个侧区水平的转移状态。
结果
本研究纳入 310 例患者，58 例（18.7%）出现 LLNR。多因素分析确定了 6 个独立的危险因素，包括肿瘤直径、病理 T4 期、中央区淋巴结受累数目、pTNM 分期、甲状腺外侵犯和 I 治疗（P 值均<0.05）。26 例（44.8%）在 II 区、38 例（65.5%）在 III 区、30 例（51.7%）在 IV 区、8 例（13.8%）在 V 区发现 LLNR。II、III、IV 和 V 区阳性侧区淋巴结数目分别为 44（22.9%）、76（39.6%）、63（32.8%）和 9（4.9%）。
结论
对于行中央区清扫术的 cN1a PTC 患者，肿瘤直径≥2cm、病理 T4 期、中央区淋巴结受累数目≥3、pTNM 分期 III-IV 期、甲状腺外侵犯、以及未接受 I 治疗是 LLNR 的独立预测因素，更有可能发生在 III 区和 IV 区。
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