Latero-cervical lymph node metastases (N1b) represent an additional risk factor for papillary thyroid cancer outcome
Latero-cervical lymph node metastases (N1b) represent an additional risk factor for papillary thyroid cancer outcome
复制标题
DOI：
10.1007/s40618-017-0714-y
复制
发表时间：
2017-12-01
影响因子：
5.4
通讯作者：
Pellegriti, G.
中科院分区：
文献类型：
--
作者：
Sapuppo, G.;Palermo, F.;Pellegriti, G.
目的甲状腺乳头状癌（Papillary thyroid carcinoma，PTC）是最常见的甲状腺癌组织类型，即使扩散到颈部淋巴结（neck lymph node，LN）也有良好的预后。淋巴结转移部位对预后的影响仍有争议。本研究的目的是评估LN转移的数量和位置的临床相关性，在PTC.Methods介绍，这一回顾性研究包括一个连续系列的1653 PTC患者随访平均为5.9年的转诊甲状腺癌诊所。所有患者均接受了甲状腺切除术，至少剥离了6个淋巴结。根据LN状态，将患者分为569例N 0（34.4%），644 N1 a（39.0%，中央室）和440 N1 b结果N1 b组的诊断年龄明显低于N1 b组，（39.8，IQR 30.7-51.6）和N1 a（40.1，IQR 31.3-50.1）比N 0（44.7，IQR 36.6-55.0）年。男性在N1 b中的比例高于N1 a和N 0（F/M分别为1.9/1、4.0/1和5.5/1）。在末次控制时，N1 b（29.8%）中持续/复发疾病的发生率显著高于N1 a（14.3%），N1 a中显著高于N 0（4.2%）（均为p < 0.01）。此外，N1 b（14.1%）的远处转移显著（p < 0.001）高于N1 a（4.3%）和N 0（1.6%）。结论颈外侧淋巴结转移（N1 b）患者的持续/复发和远处转移明显高于颈外侧淋巴结转移（N1 b）患者，淋巴结转移部位应作为术后风险分层的依据。
Purpose Papillary thyroid carcinoma (PTC), the most common thyroid cancer histotype, has a good prognosis even when spread to the neck lymph node (LN). The prognostic role of LN metastases' location is still controversial. The aim of the present study was to evaluate the clinical relevance of the number and location of LN metastases at presentation in PTCs.Methods This retrospective study included a consecutive series of 1653 PTC patients followed for a mean period of 5.9 years in a referral thyroid cancer clinic. All patients have undergone thyroidectomy with the dissection of at least six LNs. According to the LN status, patients were subdivided into 569 N0 (34.4%), 644 N1a (39.0%, central compartment) and 440 N1b (26.6%, latero-cervical compartment).Results Age at diagnosis was significantly lower in N1b (39.8, IQR 30.7-51.6) and N1a (40.1, IQR 31.3-50.1) than in N0 (44.7, IQR 36.6-55.0 yrs). The male gender was more prevalent in N1b than in N1a and N0 (F/M = 1.9/1, 4.0/1 and 5.5/1, respectively). Persistent/recurrent disease at last control was significantly more frequent in N1b (29.8%) than in N1a (14.3%), and in N1a than in N0 (4.2%) (p < 0.01 for all). Also, distant metastases were significantly (p < 0.001) more frequent in N1b (14.1%) than in N1a (4.3%) and N0 (1.6%). LN metastases' number (> 5) was a significant risk factor for persistent/recurrent disease only for N1a patients.Conclusions These data indicate that persistent/recurrent disease and distant metastases are significantly more frequent in patients with latero-cervical LN (N1b) metastases and that the LN location should be used for a better postsurgical risk stratification.