Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia
Central lymph node metastasis in papillary thyroid microcarcinoma can be stratified according to the number, the size of metastatic foci, and the presence of desmoplasia
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DOI：
10.1016/j.surg.2014.05.023
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发表时间：
2015-01-01
期刊：
影响因子：
3.8
通讯作者：
Kim, Min Joo
中科院分区：
文献类型：
--
作者：
Cho, Soo Youn;Lee, Tae Hyun;Kim, Min Joo
背景。淋巴结（LN）转移是常见的乳头状甲状腺微癌（PTMC）。本研究的目的是探讨淋巴结转移及其危险分层对PTMC复发的影响。我们回顾性地回顾了2005年至2006年在同一机构接受手术的336例PTMC患者的资料。根据淋巴结转移灶的数量、转移灶与切除灶的比例、淋巴结转移灶的大小、有无淋巴结外延伸和结缔组织增生进行淋巴结转移分层。在336例患者中，93例（28%）有淋巴结转移。随访5.3年，16例（4.8%）出现局部复发。在多个临床病理因素中，淋巴结转移是最重要的复发危险因素（P = 0.02）。淋巴结外侧转移与无复发生存相关（P < 0.01），而中央淋巴结转移与无复发生存无关（P = 0.20）。中枢性淋巴结转移分层时，高转移灶数（>= 3）、较大转移灶（>= 0.2 cm）和结缔组织增生与无复发生存率相关（P < 0.05）。中枢性淋巴结转移的预后意义可根据转移灶的数量、转移灶的大小和有无结缔组织增生而有所不同。对于转移性LNs数量多、转移灶较大以及LNs中存在结缔组织形成的患者，应积极治疗并仔细观察PTMC复发。
Background. Lymph node (LN) metastasis is common in papillary thyroid microcarcinoma (PTMC). The aim of this study was to investigate the impact of LN metastasis and its risk stratification on PTMC recurrence.Methods. We retrospectively reviewed the data of 336 patients with PTMC who underwent surgery from 2005 to 2006 at a single institution. LN metastasis was stratified according to the number of metastatic LNs, the ratio of metastatic to removed LNs, the size of metastatic foci in LNs, and the presence of extranodal extension and desmoplasia.Results. Of the 336 patients, 93 (28%) had LN metastasis. During the follow-up of 5.3 years, 16(4.8%) experienced locoregional recurrence. Among several clinicopathologic factors, LN metastasis was the most important risk factor for recurrence (P = .02). Lateral LN metastasis was correlated with recurrence-free survival (P < .01), whereas central LW metastasis was not (P = .20). When central LN metastasis was stratified, a high number of metastatic LNs (>= 3), larger metastatic foci (>= 0.2 cm), and the presence of desmoplasia were associated with recurrence-free survival (P < .05).Conclusion. The prognostic significance of central LN metastasis can differ according to the number of metastatic LNs, the size of metastatic foci, and the presence of desmoplasia. Patients with a high number of metastatic LNs, larger metastatic foci, and presence of desmoplasia in LNs should be treated aggressively and supervised carefully for PTMC recurrence.