Association of Lymph Node Density With Survival of Patients With Papillary Thyroid Cancer
Association of Lymph Node Density With Survival of Patients With Papillary Thyroid Cancer
复制标题
DOI：
10.1001/jamaoto.2017.2416
复制
发表时间：
2018-02-01
影响因子：
7.8
通讯作者：
Zafereo, Mark E.
中科院分区：
文献类型：
--
作者：
Amit, Moran;Tam, Samantha;Zafereo, Mark E.
淋巴结转移在甲状腺乳头状癌（PTC）中很常见，但淋巴结转移对生存率的影响尚不清楚。淋巴结密度（LND）是切除的阳性淋巴结数量与切除的淋巴结总数之间的比值。淋巴结密度已被建议作为一个预后因素在许多类型的cancer.Objective评估预后作用LND在PTC.DESIGN，设置，和参与者这项队列研究回顾了PTC患者的医疗记录谁是治疗在德克萨斯大学MD安德森癌症中心2000年1月1日至2015年12月31日。采用Kaplan-Meier法计算生存率和复发率。单因素分析中的重要变量采用考克斯比例风险回归多因素模型。主要结果和指标主要研究结果是疾病特异性生存期（DSS）;其他指标包括总生存期（OS）。（1801例[71%]男性;中位年龄48岁[范围18-97岁]），中位随访时间55个月（范围4-192个月）。LND ≤ 0.19的患者的10年疾病特异性生存率为98%，而LND> 0.19的患者的10年疾病特异性生存率为90%（效应量，8%; 95%CI，4%-15%）。LND ≤ 0.19的患者的10年总生存率为87%，而LND> 0.19的患者为79%（效应量，8%; 95%CI，3%-15%）。多变量分析显示，LND大于0.19与不良DSS（风险比[HR]，4.11; 95% CI，2.11-8.97）和OS（HR，1.96; 95% CI，1.24-4.11）独立相关。对18个或更多淋巴结的患者进行的亚组分析显示，LND大于0.19仍然是DSS（HR，2.94; 95% CI，1.36-9.81）和OS（HR，2.26; 95% CI，1.12-5.34）的显著标志物。将LND纳入目前的美国癌症联合委员会分期系统成功分层的风险组相比，传统的TNM分期system.CONCLUSIONS和RELEVANCE这一单一的研究所的研究表明，作为一个预测结果的重现性LND在PTC。淋巴结密度可能有助于识别生存率较差的患者，这些患者可能从更积极的辅助治疗中获益。
IMPORTANCE Lymph node metastases are common in papillary thyroid cancer (PTC), yet the impact of nodal metastases on survival remains unclear. Lymph node density (LND) is the ratio between the number of positive lymph nodes excised and the total number of excised lymph nodes. Lymph node density has been suggested as a prognostic factor in many types of cancer.OBJECTIVE To evaluate the prognostic role of LND in PTC.DESIGN, SETTING, AND PARTICIPANTS This cohort study reviewed medical records of patients with PTC who were treated at the University of Texas MD Anderson Cancer Center between January 1, 2000, and December 31, 2015. Survival and recurrence outcomes were calculated by using the Kaplan-Meier method. Significant variables on univariate analysis were subjected to a Cox proportional hazards regression multivariate model.MAIN OUTCOMES AND MEASURES Primary study outcomewas disease-specific survival (DSS); other measurements included overall survival (OS).RESULTS The study cohort included data for 2542 patients (1801 [71%] male; median age, 48 years [range, 18-97 years]) with a median follow-up of 55 months (range, 4-192 months). The 10-year disease-specific survival rate was 98% for patients with LND of 0.19 or less, compared with 90% for those with LND greater than 0.19 (effect size, 8%; 95% CI, 4%-15%). The 10-year overall survival was 87% for patients with LND of 0.19 or less, compared with 79% for patients with LND greater than 0.19 (effect size, 8%; 95% CI, 3%-15%). Multivariable analysis revealed that LND greater than 0.19 was independently associated with an adverse DSS (hazard ratio [HR], 4.11; 95% CI, 2.11-8.97) and OS (HR, 1.96; 95% CI, 1.24-4.11). Subgroup analysis of patients with 18 or more lymph nodes analyzed revealed that LND greater than 0.19 remained a significant marker for DSS (HR, 2.94; 95% CI, 1.36-9.81) and OS (HR, 2.26; 95% CI, 1.12-5.34). Incorporating LND into the current American Joint Committee on Cancer staging system successfully stratified risk groups compared with the traditional TNM staging system.CONCLUSIONS AND RELEVANCE This single-institute study demonstrates the reproducibility of LND as a predictor of outcomes in PTC. Lymph node density can potentially assist in identifying patients with poorer survival who may benefit from more aggressive adjuvant therapy.