Gao Luying, Li Xiaoyi, Xia Yu, Liu Chunhao, Ma Liyuan, Ji Jiang, An Yuang, Pan Aonan, Luo Nengwen, Jiang Yuxin
Department of Ultrasound, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China.
Department of General Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College Hospital, Beijing, China.
Quant Imaging Med Surg. 2024 Dec 5;14(12):9477-9485. doi: 10.21037/qims-23-1737. Epub 2024 Jul 11.
Pre-operative detection of skip metastasis in papillary thyroid cancer (PTC) is significant in preventing recurrence. The study aimed to investigate the characteristics and prognosis of skip metastasis to lateral neck in PTC patients by a cross-sectional study.
Between 2013 and 2016, 494 patients who underwent thyroidectomy for PTC and positive lateral lymph node metastases (LLNM) were retrospectively identified. Among them, we encountered 38 patients with skip metastasis, which was all confirmed by the histological examination. Recurrence/persistence rates were analyzed during follow-up. To determine the risk variables, patients with different skip metastasis statuses were compared according on sonographic and clinicopathological factors.
Among the PTC patients with LLNM, 7.7% had skip metastasis. The most common distribution model of skip metastasis was 1 level (63.2%), and level III (71.1%) was most frequently involved. We discovered that skip metastasis was associated with tumors in the upper portion of the thyroid, and patients with pathological low-volume LLNM [≤5 lymph nodes (LNs)] were more likely to have skip metastasis. Some 16.7% of patients with skip metastases who had a median follow-up of 45 months had recurrence or persistence. Recurrence/persistence-free survival rates at 3 and 5 years were 93.3% and 74.7%, respectively. The recurrence/persistence rate of PTC patients with skip metastasis was equal to those with LLNM (P=0.08).
Particularly for patients who had tumors in the upper portion with low-volume LLNM, a thorough preoperative examination of the lateral LNs should be necessary. Skip metastasis is not uncommon in PTC patients with LLNM, and with appropriate treatment the prognosis is equal to that of those with LLNM.
术前检测甲状腺乳头状癌（PTC）中的跳跃转移对于预防复发具有重要意义。本研究旨在通过横断面研究探讨PTC患者颈部侧方跳跃转移的特征及预后。
回顾性分析2013年至2016年间494例行甲状腺切除术且伴有侧方淋巴结转移（LLNM）阳性的PTC患者。其中，我们发现38例有跳跃转移，均经组织学检查确诊。随访期间分析复发/持续率。为确定风险变量，根据超声和临床病理因素比较不同跳跃转移状态的患者。
在伴有LLNM的PTC患者中，7.7%有跳跃转移。跳跃转移最常见的分布模式为1个区域（63.2%），最常累及的是Ⅲ区（71.1%）。我们发现跳跃转移与甲状腺上部肿瘤有关，且病理上低体积LLNM[≤5个淋巴结（LNs）]的患者更易发生跳跃转移。约16.7%有跳跃转移的患者中位随访45个月后出现复发或持续存在。3年和5年的无复发/持续生存率分别为93.3%和74.7%。有跳跃转移的PTC患者的复发/持续率与有LLNM的患者相当（P = 0.08）。
特别是对于甲状腺上部有肿瘤且LLNM体积小的患者，术前应彻底检查侧方淋巴结。跳跃转移在伴有LLNM的PTC患者中并不少见，经适当治疗后预后与伴有LLNM的患者相当。
