Zhang Yu, Ji Xiaoyu, Zhang Xialing, Wang Yu
Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai, China.
Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
Gland Surg. 2024 Nov 30;13(11):1921-1930. doi: 10.21037/gs-24-299. Epub 2024 Nov 26.
As the most prevalent histological type of thyroid cancer, the prognosis of papillary thyroid cancer (PTC) is closely related to cervical lymph node metastasis (LNM), particularly in the case of lateral LNM (LLNM). The patterns of cervical LNM in PTC remain inconclusive. We aim to assess the risk factors for LLNM and extranodal extension (ENE) at different lateral levels in N1b PTC patients.
A total of 486 PTC patients with pathologically diagnosed N1b, who underwent thyroidectomy with central and lateral neck lymph node dissection at our hospital between January 2019 and December 2021, were retrospectively retrieved. The metastatic status of different lateral levels was recorded. Further correlation analysis was conducted.
Based on the correlation analysis, binary logistic regression analysis indicated that upper location [odds ratio (OR) =3.067; P<0.001; 95% confidence interval (CI): 2.075-4.534] and central LNM-ENE (CLNM-ENE) (OR =2.036; P=0.04; 95% CI: 1.044-3.970) are predictive factors for level II metastasis. Additionally, upper location (OR =2.106; P<0.001; 95% CI: 1.404-3.159) and CLNM (OR =2.664; P<0.001; 95% CI: 1.681-4.222) were found to be predictive factors for level III metastasis. LLNM at level IV was closely associated only with CLNM. Level III-ENE (OR =2.347; P=0.03; 95% CI: 1.065-5.176) was found to be highly correlated with level V metastasis. As for ENE, level III-ENE was found to be a risk factor for ENE in all other levels (II, IV, V), while ENE in the other lateral cervical regions also increased the risk for level III.
Despite some uncertainties, LLNM remains closely associated with the upper location of PTC. Meanwhile, level III functions as the hub of the lateral neck, with level III-ENE increasing the risk of LLNM in level V, and significantly raising the probability of ENE in other lateral cervical regions. LLNM have its inherent patterns, as evidenced in the study, but also have a degree of unpredictability, therefore an accurate preoperative assessment is essential.
作为甲状腺癌最常见的组织学类型，甲状腺乳头状癌（PTC）的预后与颈部淋巴结转移（LNM）密切相关，尤其是侧方LNM（LLNM）的情况。PTC颈部LNM的模式仍无定论。我们旨在评估N1b期PTC患者不同侧方水平发生LLNM和结外侵犯（ENE）的危险因素。
回顾性检索了2019年1月至2021年12月期间在我院接受甲状腺切除术并进行中央区和侧颈部淋巴结清扫的486例病理诊断为N1b期的PTC患者。记录不同侧方水平的转移状态，并进行进一步的相关性分析。
基于相关性分析，二元逻辑回归分析表明，肿瘤上极位置[比值比（OR）=3.067；P<0.001；95%置信区间（CI）：2.075 - 4.534]和中央区LNM-ENE（CLNM-ENE）（OR =2.036；P=0.04；95% CI：1.044 - 3.970）是Ⅱ区转移的预测因素。此外，肿瘤上极位置（OR =2.106；P<0.001；95% CI：1.404 - 3.159）和CLNM（OR =2.664；P<0.001；95% CI：1.681 - 4.222）被发现是Ⅲ区转移的预测因素。Ⅳ区的LLNM仅与CLNM密切相关。Ⅲ区ENE（OR =2.347；P=0.03；95% CI：1.065 - 5.176）与Ⅴ区转移高度相关。至于ENE，Ⅲ区ENE被发现是所有其他区域（Ⅱ、Ⅳ、Ⅴ区）发生ENE的危险因素，而其他侧颈部区域的ENE也增加了Ⅲ区发生ENE的风险。
尽管存在一些不确定性，但LLNM仍与PTC的上极位置密切相关。同时，Ⅲ区是侧颈部的枢纽，Ⅲ区ENE增加了Ⅴ区LLNM的风险，并显著提高了其他侧颈部区域发生ENE的概率。LLNM有其内在模式，如本研究所示，但也有一定程度的不可预测性，因此准确的术前评估至关重要。
