Bakkar Sohail, Chorti Angeliki, Papavramidis Theodosis, AlHalaseh Mais, Aljarrah Qusai, Donatini Gianluca, Miccoli Paolo
Department of General and Specialized Surgery, Faculty of Medicine, The Hashemite University, Zarqa, Jordan.
1st Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki (AUTH), Thessaloniki, Greece.
Endocrine. 2025 Jul;89(1):119-124. doi: 10.1007/s12020-025-04209-8. Epub 2025 Mar 1.
Disease-free survival is the main outcome of interest considered when assessing the effectiveness of surgical management of papillary thyroid carcinoma (PTC). Specific characteristics of nodal metastases have been demonstrated to impact the risk of recurrence.
Verify the oncologic rationale of prophylactic central compartment neck dissection (pCCND) in the management of PTC by comparing the pathologic spectrum of lymph nodes in patient's undergoing pCCND vs. therapeutic CCND (tCCND).
Between May 2017 and October 2018, 257 patients underwent total thyroidectomy for PTC. pCCND was performed for clinically uninvolved nodes, and tCCND for clinically apparent nodal disease. Harvested metastatic nodes from each group were compared in terms of number, size, and the presence of extranodal extension. Cut-off values for the size and number were 2 mm and 5, respectively. Patients were followed until October 2023.
78 patients underwent tCCND. Whereas pCCND was performed in 179 patients. The mean number of nodes harvested in tCCND was 14 (9-31), and 9 (5-24) in pCCND (p < 0.0001). Node positivity was 84.6, and 37.4%, respectively (p < 0.0001). ≥5 metastatic nodes were harvested in 66.6% of tCCND vs. 7.5% of pCCND (p < 0.0001). 73% of tCCND had a metastatic node ≥2 mm in size vs. 2.5% of pCCND (p < 0.0001). Extranodal extension occurred in 25% of tCCND vs. 2.5% of pCCND (p = 0.01). Recurrence rate was 3.8% in tCCND vs. none in pCCND (p = 0.008).
Clinically inapparent nodal disease has a pathological spectrum with insignificant impact on disease recurrence. Therefore, pCCND does not seem to be oncologically meaningful.
无病生存期是评估甲状腺乳头状癌（PTC）手术治疗效果时主要关注的结果。已证实淋巴结转移的特定特征会影响复发风险。
通过比较接受预防性中央区颈淋巴结清扫术（pCCND）与治疗性中央区颈淋巴结清扫术（tCCND）患者的淋巴结病理谱，验证pCCND在PTC治疗中的肿瘤学合理性。
2017年5月至2018年10月期间，257例患者因PTC接受了全甲状腺切除术。对临床未受累的淋巴结进行pCCND，对临床明显的淋巴结疾病进行tCCND。比较两组采集的转移淋巴结的数量、大小和有无结外侵犯情况。大小和数量的截断值分别为2毫米和5个。对患者进行随访至2023年10月。
78例患者接受了tCCND。179例患者接受了pCCND。tCCND采集的淋巴结平均数量为14个（9 - 31个），pCCND为9个（5 - 24个）（p < 0.0001）。淋巴结阳性率分别为84.6%和37.4%（p < 0.0001）。66.6%的tCCND采集到≥5个转移淋巴结，而pCCND为7.5%（p < 0.0001）。73%的tCCND有一个大小≥2毫米的转移淋巴结，而pCCND为2.5%（p < 0.0001）。25%的tCCND发生了结外侵犯，pCCND为2.5%（p = 0.01）。tCCND的复发率为3.8%，pCCND无复发（p = 0.008）。
临床隐匿性淋巴结疾病的病理谱对疾病复发影响不大。因此，pCCND在肿瘤学上似乎没有意义。
