Lateral Neck Lymph Node Characteristics Prognostic of Outcome in Patients with Clinically Evident N1b Papillary Thyroid Cancer.
Lateral Neck Lymph Node Characteristics Prognostic of Outcome in Patients with Clinically Evident N1b Papillary Thyroid Cancer.
复制标题
DOI：
10.1245/s10434-015-4398-2
复制
发表时间：
2015-10
影响因子：
3.7
通讯作者：
Ganly I
中科院分区：
文献类型：
--
作者：
Wang LY;Palmer FL;Nixon IJ;Tuttle RM;Shah JP;Patel SG;Shaha AR;Ganly I
探讨甲状腺乳头状癌伴明显淋巴结病变患者侧淋巴结（LN）特征对预后的预测作用。从3664例分化甲状腺癌的机构数据库中，共鉴定出438例乳头状甲状腺癌侧颈部转移患者。记录阳性LN数、最大LN大小、阳性LN数与切除总LN数之比（LN负担）以及有无结外扩散（ENS）。连续变量的截止点由接收机工作特性曲线确定。通过Kaplan-Meier法和Cox比例风险模型确定预测无复发生存和疾病特异性生存（DSS）的LN变量。中位年龄41岁（范围5-86岁）。中位随访时间为65个月（1 - 332个月）。59例出现疾病复发；5例为局部，40例为局部，30例为远处。15名病人死于疾病。接收器工作特性截止值为bb1010个正LNs和bb1170%的LN负荷。没有侧面LN特征预测DSS。在<45岁的患者中，复发的单因素预测因子为>10阳性淋巴结（p = 0.049）和>17 % （p < 0.001）。在≥45岁的患者中，>0阳性淋巴结、> 17%的LN负担和ENS的存在是复发的预测因素（p = 0.019、p = 0.019和p = 0.029）。侧颈部淋巴结负荷bbb17 %（6个淋巴结中1个淋巴结阳性）预示着所有年龄段患者的复发，而ENS也预示着老年患者的复发。
To identify lateral lymph node (LN) characteristics predictive of outcome in papillary thyroid cancer patients with clinically evident nodal disease. A total of 438 patients with lateral neck metastases from papillary thyroid cancer were identified from an institutional database of 3,664 differentiated thyroid cancers. The number of positive LNs, size of the largest LN, number of positive LNs to total number of LNs removed (LN burden), and presence of extranodal spread (ENS) were recorded. Cutoffs for continuous variables were determined by receiver operating characteristic curves. LN variables predictive of recurrence free survival and disease-specific survival (DSS) were identified by the Kaplan–Meier method and the Cox proportional hazard model. The median age was 41 years (range 5–86 years). The median follow-up was 65 months (range 1– 332 months). Fifty-nine patients developed disease recurrence; these were local in five, regional in 40, and distant in 30 patients. Fifteen patients died of disease. Receiver operating characteristic cutoffs were>10 positive LNs and a LN burden >17 %. No lateral LN characteristics were predictive of DSS. In patients <45 years old, univariate predictors of recurrence were >10 positive nodes (p = 0.049) and LN burden >17 % (p < 0.001). In patients ≥45 years old, >10 positive nodes, LN burden >17 %, and presence of ENS were predictive of recurrence (p = 0.019, p = 0.019, and p = 0.029, respectively). LN burden >17 % (1 positive LN in 6 LNs removed) in the lateral neck is predictive for recurrence in patients of all ages, whereas ENS is also prognostic for recurrence in older patients.