Park Joonseon, Kim Sue Youn, Jung Chan Kwon, An Solji, Bae Ja Seong, Kim Kwangsoon
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Endocr Pract. 2025 Jun 3. doi: 10.1016/j.eprac.2025.05.747.
Perineural invasion (PNI) in thyroid cancer is a relatively rare but significant pathologic feature with crucial implications for prognosis and management. This study investigates the impact of PNI on recurrence and lateral neck lymph node metastasis (N1b) in patients with thyroid cancer.
This retrospective analysis included 8572 patients with thyroid cancer who underwent surgery from January 2000 to December 2020 at Seoul St. Mary's Hospital. Clinicopathologic characteristics and outcomes were compared between the patients with and without PNI before and after propensity score matching (PSM). The logistic regression analysis identified the risk factors for N1b, whereas the Cox regression analysis determined the risk factors for recurrence.
Of the 8572 patients, 144 (1.7%) presented with PNI. The PNI group had higher rates of gross extrathyroidal extension, vascular and lymphatic invasion, and advanced TNM stage. The recurrence rates were higher in the PNI group both before (11.1% vs 5.6%) and after PSM (11.3% vs 5.6%). PNI was a significant risk factor for N1b in the univariate logistic regression analysis but not in the multivariate analysis before and after PSM. The Cox regression analysis revealed that PNI is a significant risk factor for recurrence before PSM but not after PSM.
The PNI in thyroid cancer was associated with higher recurrence rates and increased N1b. However, it was not considered a significant independent risk factor for recurrence or N1b. Further research is needed to refine the management strategies for patients with PNI to improve prognosis.
甲状腺癌中的神经周围侵犯（PNI）是一种相对罕见但重要的病理特征，对预后和治疗具有关键意义。本研究调查了PNI对甲状腺癌患者复发和侧颈淋巴结转移（N1b）的影响。
这项回顾性分析纳入了2000年1月至2020年12月在首尔圣玛丽医院接受手术的8572例甲状腺癌患者。在倾向评分匹配（PSM）前后，对有和无PNI的患者的临床病理特征和结局进行了比较。逻辑回归分析确定了N1b的危险因素，而Cox回归分析确定了复发的危险因素。
在8572例患者中，144例（1.7%）出现PNI。PNI组的甲状腺外大体侵犯、血管和淋巴管侵犯以及TNM分期较高。PNI组在PSM前（11.1%对5.6%）和PSM后（11.3%对5.6%）的复发率均较高。在单因素逻辑回归分析中，PNI是N1b的显著危险因素，但在PSM前后的多因素分析中不是。Cox回归分析显示，PNI在PSM前是复发的显著危险因素，但在PSM后不是。
甲状腺癌中的PNI与较高的复发率和增加的N1b相关。然而，它不被认为是复发或N1b的显著独立危险因素。需要进一步研究以完善PNI患者的治疗策略，改善预后。
