Prophylactic Central Neck Dissection Might Not Be Necessary in Papillary Thyroid Carcinoma: Analysis of 11,569 Cases from a Single Institution
Prophylactic Central Neck Dissection Might Not Be Necessary in Papillary Thyroid Carcinoma: Analysis of 11,569 Cases from a Single Institution
复制标题
DOI：
10.1016/j.jamcollsurg.2016.02.001
复制
发表时间：
2016-05-01
影响因子：
5.2
通讯作者：
Kim, Jee Soo
中科院分区：
文献类型：
--
作者：
Kim, Seo Ki;Woo, Jung-Woo;Kim, Jee Soo
背景：预防性中央颈淋巴清扫术(PCND)在临床结节阴性(CN0)的乳头状甲状腺癌(PTC)中的益处仍然存在争议。本研究旨在探讨pCND对大量cN0 PTC患者的临床影响。研究设计：对1997年1月至2015年6月间接受甲状腺切除术的11569例cN0 PTC患者进行调查。应用COX多因素分析，根据不同的临床病理条件，采用子集分析评估pCND对预后的影响。结果：在11569例cN0 PTC患者中，8735例(75.5%)接受了pCND。预防性CND不能显著降低cN0PTC患者局部复发的风险(调整后的风险比[HR]=0.874；p=0.392)。此外，在不同的手术方式(肺叶切除加同侧pCND[调整后HR=0.636；p=0.131]、全甲状腺切除加同侧pCND[调整后HR=0.775；p=0.164]、全甲状腺切除加双侧pCND[调整后HR=1.041；p=0.821])，pCND并未显著降低局部区域复发的风险。然而，在pCND(+)组中，手术并发症，如暂时性声带麻痹(5.6%vs2.5%；p=0.001)、暂时性甲状旁腺功能减退(30.8%vs16.7%；p<；0.001)和永久性甲状旁腺功能减退症(3.5%vs1.7%；p<；0.001)明显更常见。我们建议将CND保留用于治疗情况。(C)2016年由美国外科医师学会颁发。爱思唯尔公司出版，版权所有。
BACKGROUND: The benefits of prophylactic central neck dissection (pCND) remain controversial in clinically node-negative (cN0) papillary thyroid carcinoma (PTC). The purpose of this study was to investigate the clinical impact of pCND with a large group of cN0 PTC patients.STUDY DESIGN: A total of 11,569 cN0 PTC patients who underwent thyroidectomy between January 1997 and June 2015 were investigated. Using Cox multivariate analysis, the prognostic impact of pCND was assessed using subset analyses according to various clinicopathologic conditions. Using propensity score matching, various surgical morbidities were assessed under adjusted conditions.RESULTS: Of 11,569 cN0 PTC patients, 8,735 (75.5%) underwent pCND. Prophylactic CND did not significantly decrease the risk of locoregional recurrence in cN0 PTC patients (adjusted hazard ratio [HR] = 0.874; p = 0.392). In addition, pCND did not significantly decrease the risk of locoregional recurrence in various surgical extents (lobectomy and ipsilateral pCND [adjusted HR = 0.636; p = 0.131], total thyroidectomy and ipsilateral pCND [adjusted HR = 0.775; p = 0.164], and total thyroidectomy and bilateral pCND [adjusted HR = 1.041; p = 0.821]). However, surgical morbidities, such as temporary vocal cord palsy (5.6% vs 2.5%; p = 0.001), temporary hypoparathyroidism (30.8% vs 16.7%; p < 0.001), and permanent hypoparathyroidism (3.5% vs 1.7%; p < 0.001) were significantly more frequent in the pCND(+) group.CONCLUSIONS: Given the lack of proven benefits and the clear evidence of morbidities, pCND cannot be recommended as a routine procedure. We suggest that CND be reserved for therapeutic situations. (C) 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.