Optimization of Staging of the Neck With Prophylactic Central and Lateral Neck Dissection for Papillary Thyroid Carcinoma
Optimization of Staging of the Neck With Prophylactic Central and Lateral Neck Dissection for Papillary Thyroid Carcinoma
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DOI：
10.1097/sla.0b013e31824b7b68
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发表时间：
2012-04-01
影响因子：
9
通讯作者：
Travagli, Jean-Paul
中科院分区：
文献类型：
--
作者：
Hartl, Dana M.;Leboulleux, Sophie;Travagli, Jean-Paul
目的：分析甲状腺乳头状癌预防性中央淋巴结清扫术（CND）和侧颈淋巴结清扫术（LND）的淋巴结转移率（PN 1）、PN 1的危险因素和预后。辅助放射性碘治疗可调制，但是，通过手术分期的neck.Methods：回顾性研究，连续患者超声分类cN 0预防性CND治疗，和横向LND（III级和IV级）。结果：317例患者（女性254例，平均年龄44岁，平均肿瘤大小17 mm）中，单侧CND淋巴结清扫5例，双侧CND 9例，LND 12例。pN 1期占42%：单侧CND为23%，双侧CND为39%，LND为23%（转移性淋巴结的中位数= 2）。55%的pN 1期患者在侧颈有转移性淋巴结。10%的患者有超过10个转移性淋巴结和/或超过3个淋巴结伴包膜外扩散。pN 1与肿瘤大小（P = 0.0025）、甲状腺外肿瘤扩展（P < 0.0001）、男性（P = 0.0006）和年龄小于45岁（P = 0.0003）相关。永久性甲状旁腺功能减退和无意性喉返神经麻痹各2例。pN 0期患者的放射性碘摄入量低于pN 1期患者（中位数30 vs 100 mCi，P < 0.0001）。预防性CND联合LND优化了分期，为辅助放射性碘的个性化方法提供了基础。
Objective: To analyze the yield and rate of node metastases (pN1) for prophylactic central (CND) and lateral neck dissection (LND) for papillary thyroid carcinoma, the risk factors for pN1, and outcomes.Background: Prophylactic CND and LND are not routinely employed. Adjuvant radioiodine treatment may be modulated, however, by surgical staging of the neck.Methods: Retrospective study, consecutive patients ultrasonographically classified cN0 treated with prophylactic CND, and lateral LND (levels III and IV). The number of nodes was resected and the incidence of pN1 was recorded.Results: For 317 patients (254 women, mean age 44 years, mean tumor size 17 mm), the number of lymph nodes was 5 for unilateral CND, 9 for bilateral CND, and 12 for LND. pN1 stage was 42% overall: 23% for unilateral CND, 39% for bilateral CND, and 23% for LND(median number of metastatic nodes = 2 for each). Fifty-five percent of the patients staged pN1 had metastatic nodes in the lateral neck. Ten percent had more than 10 metastatic nodes and/or more than 3 nodes with extra capsular spread. pN1 was correlated with tumor size (P = 0.0025), extrathyroidal tumor extension (P < 0.0001), male sex (P = 0.0006), and age younger than 45 years (P = 0.0003). Permanent hypoparathyroidism and unintentional recurrent nerve paralysis occurred in 2 cases each. Patients staged pN0 received less radioiodine than patients staged pN1 (median 30 vs 100 mCi, P < 0.0001).Conclusions: For staging, bilateral prophylactic CND is preferable to unilateral CND. Prophylactic CND with LND optimizes staging providing a basis for a personalized approach for adjuvant radioiodine.