临床淋巴结阴性的乳头状甲状腺癌预防性中央区颈部淋巴结清扫术：对手术及肿瘤学结局的10年影响
Prophylactic central neck dissection in clinically node-negative papillary thyroid carcinoma: 10-year impact on surgical and oncologic outcomes.
作者信息
Papini Piermarco, Rossi Leonardo, Matrone Antonio, De Renzis Alice, Morganti Riccardo, Valerio Laura, Ambrosini Carlo Enrico, Materazzi Gabriele, Elisei Rossella
机构信息
Department of Surgical, Medical, Molecular Pathology, and Critical Care, University of Pisa, Pisa, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
出版信息
Surgery. 2025 May;181:109258. doi: 10.1016/j.surg.2025.109258. Epub 2025 Feb 20.
BACKGROUND
The role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma is debated. This study presents the findings from a 10-year follow-up of a single-institution randomized controlled trial assessing the role of prophylactic central compartment lymph node dissection in clinically node-negative papillary thyroid carcinoma.
METHODS
Between 2008 and 2010, a total of 196 patients with clinically node-negative papillary thyroid carcinoma were randomly assigned to 2 groups in a 1:1 ratio to undergo total thyroidectomy (group A) or total thyroidectomy with prophylactic central compartment lymph node dissection (group B). Patients received low-dose radioactive iodine treatment (30 mCi) postoperatively, with additional doses as needed. Monitoring included serum thyroglobulin, thyroglobulin antibodies, and neck ultrasound imaging.
RESULTS
At the end of the follow-up, 151 patients were analyzed, after 28 from group A and 17 from group B were excluded. The 2 groups were similar in age at diagnosis (P = .643), sex distribution (P = .735), body mass index (P = .134), ultrasound-estimated thyroid volume (P = .650), and histologic tumor features. After >10 years (12.9 ± 2 years), no significant differences were observed in surgical and oncologic outcomes. The mean thyroglobulin levels were 0.1 ± 0.1 ng/mL in group A and 0.3 ± 1.3 ng/mL in group B (P = .146). Both groups showed similar findings in the need for further surgery (P = .917), for additional radioactive iodine (P = .979), and mean radioactive iodine dosage (P = .822). No difference was documented in permanent recurrent laryngeal nerve palsy (P = .640), permanent hypocalcemia (P = .238), and serum calcium level (P = .181). The only observed distinction was more parathyroid removal in prophylactic central compartment lymph node dissection cases based on histologic examination (P = .005).
CONCLUSION
Prophylactic central compartment lymph node dissection does not significantly affect surgical and oncologic outcomes in patients with clinically node-negative small papillary thyroid carcinoma after long-term follow-up.
背景
预防性中央区淋巴结清扫术在临床淋巴结阴性的乳头状甲状腺癌中的作用存在争议。本研究展示了一项单机构随机对照试验10年随访的结果，该试验评估了预防性中央区淋巴结清扫术在临床淋巴结阴性的乳头状甲状腺癌中的作用。
方法
2008年至2010年期间，共有196例临床淋巴结阴性的乳头状甲状腺癌患者按1:1比例随机分为两组，分别接受全甲状腺切除术（A组）或全甲状腺切除术加预防性中央区淋巴结清扫术（B组）。患者术后接受低剂量放射性碘治疗（30mCi），并根据需要追加剂量。监测项目包括血清甲状腺球蛋白、甲状腺球蛋白抗体和颈部超声成像。
结果
随访结束时，对151例患者进行了分析，A组排除28例，B组排除17例。两组在诊断时的年龄（P = 0.643）、性别分布（P = 0.735）、体重指数（P = 0.134）、超声估计的甲状腺体积（P = 0.650）和组织学肿瘤特征方面相似。超过10年（12.9±2年）后，手术和肿瘤学结局未观察到显著差异。A组甲状腺球蛋白平均水平为0.1±0.1ng/mL，B组为0.3±1.3ng/mL（P = 0.146）。两组在进一步手术需求（P = 0.917）、追加放射性碘需求（P = 0.979）和平均放射性碘剂量（P = 0.822）方面表现出相似的结果。在永久性喉返神经麻痹（P = 0.640）、永久性低钙血症（P = 0.238）和血清钙水平（P = 0.181）方面未记录到差异。唯一观察到的区别是，根据组织学检查，预防性中央区淋巴结清扫术病例中甲状旁腺切除更多（P = 0.005）。
结论
长期随访后，预防性中央区淋巴结清扫术对临床淋巴结阴性的小乳头状甲状腺癌患者的手术和肿瘤学结局无显著影响。
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