Central and lateral neck involvement in papillary thyroid carcinoma patients with or without thyroid capsular invasion: A multi-center analysis.
Central and lateral neck involvement in papillary thyroid carcinoma patients with or without thyroid capsular invasion: A multi-center analysis.
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DOI：
10.3389/fendo.2023.1138085
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发表时间：
2023
影响因子：
5.2
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中科院分区：
文献类型：
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定量预测伴或不伴甲状腺被膜侵犯（TCI）的甲状腺乳头状癌（PTC）患者颈部淋巴结转移的概率，指导颈部治疗策略的决策。回顾性分析了来自三个医疗中心的 998 名 PTC 患者。 TCI 阳性患者（TCI 组）比 TCI 阴性患者（无 TCI 组）表现出更高的 CLNM 和 LLNM 风险。接受侧淋巴结清扫术的患者相对严重的术后并发症的发生率明显较高。对于no-TCI组，年龄小于55岁、男性、存在双侧病变和多灶性、最大肿瘤直径(MTD)≥0.5cm等因素被确认为CLNM的独立危险因素，而存在双侧病变和同侧结节性甲状腺肿(iNG)、最大阳性CLN直径(MCLND)>1.0cm为LLNM的独立危险因素。 TCI组患者发生LLNM的独立危险因素包括MCLND>1.0cm、阳性CLN数>=3以及存在iNG。基于上述危险因素，对无TCI组和TCI组患者建立了CLNM和LLNM的预测模型。建立了细致、全面的风险分层流程图，以便更准确地评估 PTC 患者中央颈受累的风险，包括 CLNM 和 LLNM 风险。为 PTC 患者构建了细致、全面的分层流程图，用于定量评估 CLNM 和 LLNM。
To quantitatively predict the probability of cervical lymph node metastasis for papillary thyroid carcinomas (PTC) patients with or without thyroid capsular invasion (TCI), to guide the decision-making of management strategies for neck regions. A total of 998 PTC patients from three medical centers were retrospectively analyzed. Patients with positive TCI (TCI group) exhibited higher risks for both CLNM and LLNM than those with negative TCI (no-TCI group). Patients receiving lateral lymph node dissection showed significantly higher incidence of relatively severe postoperative complications. For no-TCI group, factors including age less than 55 years old, male, the presence of bilateral disease and multifocality, and maximum tumor diameter (MTD)>=0.5cm were confirmed to be independent risk factors for CLNM, while the presence of bilateral disease and ipsilateral nodular goiter (iNG), and maximum positive CLN diameter (MCLND)>1.0cm independent factors for LLNM. Independent risk factors of LLNM for patients within the TCI group included MCLND>1.0cm, positive CLN number>=3, and the presence of iNG. Predictive models of CLNM and LLNM were established based on the aforementioned risk factors for patients within no-TCI and TCI groups. A meticulous and comprehensive risk stratification flow chart was established for a more accurate evaluation of central neck involvement including both CLNM and LLNM risk in PTC patients. A meticulous and comprehensive stratification flow chart for PTC patients for quantitatively evaluating both CLNM and LLNM was constructed.