The extent of lymph node yield in central neck dissection can be affected by preoperative and intraoperative assessment and alter the prognosis of papillary thyroid carcinoma
The extent of lymph node yield in central neck dissection can be affected by preoperative and intraoperative assessment and alter the prognosis of papillary thyroid carcinoma
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中央颈清扫术的淋巴结产量范围可能会受到术前和术中评估的影响，并改变甲状腺乳头状癌的预后
DOI：
10.1002/cam4.2762
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发表时间：
2020-02-01
期刊：
影响因子：
4
通讯作者：
Ji, Qing-Hai
中科院分区：
文献类型：
--
作者：
Hu, Jia-Qian;Wen, Duo;Ji, Qing-Hai
背景：淋巴结转移率（LNY）用于甲状腺乳头状癌（PTC）患者的分层。LNY的疗效可能与手术范围有关。方法回顾性分析13712例PTC患者的临床资料，分析影响LNY的因素。评估了CND中LNY的危险因素和LNY的分布特征。结果治疗性CND组LNY明显高于预防性CND组（单侧：5.55 ± 3.79 vs 3.41 ± 2.77;双侧：8.90 ± 5.10 vs 6.47 ± 4.17，P <0.001）。其他的独立因素包括结节延伸（埃特）、肿瘤大小和并发桥本甲状腺炎。LNY在双侧CND中的不一致分布与术前和术中评估有关。结论CND手术方式、埃特、桥本氏甲状腺炎是影响LNY的独立因素。LNY分布不一致与双侧PTC患者的预后有关。术前和术中评估对CND实际程度的影响可以用来解释LNY与PTC预后的关系。
Background Lymph node yield (LNY) was implemented in the stratification of papillary thyroid cancer (PTC) patients. The effect of LNY may be related to the extent of surgery. This study aims to identify influencing factors for LNY in central compartment neck dissection (CND).Methods Data of 13 712 consecutive PTC patients were analyzed retrospectively. Risk factors for LNY in CND and distribution characteristics of LNY were evaluated. Its relationship with prognosis was studied in another cohort of 136 cases.Results LNY in therapeutic CND was significantly higher than prophylactic CND (Unilateral: 5.55 +/- 3.79 vs 3.41 +/- 2.77; Bilateral: 8.90 +/- 5.10 vs 6.47 +/- 4.17, P < .001). Other independent factors included extranodal extension (ETE), tumor size, and concurrent Hashimoto's thyroiditis. The inconsistency distribution of LNY in bilateral CND was associated with preoperative and intraoperative assessment. Patients with significant difference between major and minor LNY suffered from poorer prognosis (10y-RFS: 58.3% vs 92.0%; HR = 6.719, 95%, P < .0001).Conclusions CND surgical procedure, ETE, and Hashimoto's thyroiditis were independent factors of LNY. Inconsistent distribution of LNY was associated with prognosis of bilateral PTC patients. The impact of preoperative and intraoperative assessment on the actual extent of CND can be used to explain the relationship between LNY and PTC prognosis.