Risk Factors for Lateral Neck Recurrence of N0/N1a Papillary Thyroid Cancer
Risk Factors for Lateral Neck Recurrence of N0/N1a Papillary Thyroid Cancer
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DOI：
10.1245/s10434-017-6057-2
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发表时间：
2017-11-01
影响因子：
3.7
通讯作者：
Kim, Sang Yoon
中科院分区：
文献类型：
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作者：
Kim, Yehree;Roh, Jong-Lyel;Kim, Sang Yoon
目前的指南提倡对没有颈外侧转移（cN 1b）临床证据的甲状腺乳头状癌（PTC）不进行颈外侧室的预防性清扫。然而，侧颈复发会影响患者的治疗结果和生活质量。因此，本研究探讨了无cN 1b的PTC明确治疗后侧颈复发的风险因素。该研究纳入了1928例连续患者，这些患者在2006年至2012年期间因无cN 1b的PTC接受了甲状腺全切除术。采用Logistic回归分析确定临床病理因素与侧颈复发的关系。单因素和多因素Cox比例风险回归分析用于确定预测侧颈无复发生存率（LRFS）的因素。在中位随访94个月（范围，24-133个月）期间，47例患者（2.4%）发生侧颈复发。Logistic回归分析显示，肿瘤大小（> 2cm）、多灶性、临床颈中央转移（cN 1a）、阳性淋巴结（LN）数（> 5）和LN比值（> 0.5）与侧颈复发显著相关（P < 0.05）。多变量分析表明，多灶性（风险比[HR]，2.338; 95%置信区间[CI]，1.126-4.858; P = 0.023），cN 1a（HR，5.301; 95%CI，2.416-11.630; P < 0.001），LN比值（HR，2.628; 95% CI，1.228-5.626; P = 0.013），结旁延长（HR，2.570; 95% CI，1.063-6.213; P = 0.036）和MACIS（远处转移、患者年龄、切除完整性、局部浸润和肿瘤大小）评分N 0/N1 a PTC患者的多灶性、cN 1a、LN比值、结节性侵犯和MACIS评分是预测甲状腺切除术后侧颈复发的临床病理因素。
Current guidelines advocate no prophylactic dissection of the lateral neck compartment for papillary thyroid carcinoma (PTC) without clinical evidence of lateral neck metastasis (cN1b). However, lateral neck recurrence can affect patient treatment outcomes and quality of life. Therefore, this study examined the risk factors for lateral neck recurrence after the definitive treatment of PTC without cN1b.The study enrolled 1928 consecutive patients who underwent total thyroidectomy between 2006 and 2012 for PTC without cN1b. Logistic regression analysis was used to identify the relationship of clinicopathologic factors with lateral neck recurrence. Uni- and multivariate Cox-proportional hazards regression analyses were used to identify factors predictive of lateral neck recurrence-free survival (LRFS).During a median follow-up period of 94 months (range, 24-133 months), lateral neck recurrence occurred in 47 patients (2.4%). Binary logistic regression showed that tumor size (> 2 cm), multifocality, clinical central neck metastasis (cN1a), number of positive lymph nodes (LNs, > 5), and LN ratio (> 0.5) were significantly associated with lateral neck recurrence (P < 0.05). Multivariate analyses showed that multifocality (hazards ratio [HR], 2.338; 95% confidence interval [CI], 1.126-4.858; P = 0.023), cN1a (HR, 5.301; 95% CI, 2.416-11.630; P < 0.001), LN ratio (HR, 2.628; 95% CI, 1.228-5.626; P = 0.013), extranodal extension (HR, 2.570; 95% CI, 1.063-6.213; P = 0.036), and MACIS (distant metastasis, patient age, completeness of resection, local invasion and tumour size) score (HR, 2.513; 95% CI, 1.211-5.216; P = 0.013) were independent factors for LRFS.Lateral neck recurrence after thyroidectomy is predicted by the clinicopathologic factors of multifocality, cN1a, LN ratio, extranodal extension, and MACIS score in N0/N1a PTC patients.