Prophylactic Central Neck Dissection in Papillary Thyroid Carcinoma: All Risks, No Reward.
Prophylactic Central Neck Dissection in Papillary Thyroid Carcinoma: All Risks, No Reward.
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DOI：
10.1016/j.jss.2021.02.035
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Chen H
中科院分区：
文献类型：
--
作者：
Dismukes J;Fazendin J;Obiarinze R;Márquez GCH;Ramonell KM;Buczek E;Lindeman B;Chen H
对于中央区临床阴性淋巴结（cN0）的甲状腺乳头状癌（PTC）患者，中央颈清扫术（CND）仍然是一种有争议的干预措施。支持者指出，cN0 患者的 CND 可以预防局部复发，而反对者则认为并发症的风险超过了任何潜在的益处。因此，评估接受 CND 的 cN0 PTC 患者的肿瘤学和手术结果的研究之间仍然存在相互矛盾的结果。为了澄清这一争议，我们试图评估 CND 对我们机构的 cN0 PTC 患者的疗效、安全性和肿瘤学影响。使用机构癌症登记处和补充电子病历查询，确定了 1998 年至 2018 年间在我们机构接受甲状腺切除术的 695 名 PTC 患者。根据患者是否接受 CND 进行分层；分别标识为 CND(+) 或 CND(−)。患者还根据是否接受辅助放射性碘（RAI）治疗进行分层。对患者人口统计、病理结果以及手术和肿瘤结果进行了审查。酌情使用方差分析和/或 t 检验和卡方检验进行标准统计分析。在 695 名 PTC 患者中，492 名 (70.8%) 的临床和放射学淋巴结阴性疾病 (cN0)。平均年龄为 50 ± 1 岁，其中 368 名 (74.8%) 为女性。在 cN0 PTC 患者中，61 名患者 (12.4%) 接受了 CND。与 CND(-) 患者相比，CND(+) 患者术前促甲状腺激素 (TSH) 值较高，分别为 2.8 ± 0.8 和 1.5 ± 0.2 mU/L (P = 0.028)。与 CND(−) 患者相比，在平均随访 38 ± 3 个月时，CND 并未显着减少疾病复发、远处转移性疾病的发生 (P = 0.105) 或疾病持续存在 (P = 0.069)。然而，CND（+）患者的手术发病率明显更高；包括短暂性低钙血症（36.1% vs 14.4%；P < 0.001）、短暂性喉返神经（RLN）损伤（19.7% vs 7.0%；P < 0.001）和永久性 RLN 损伤（3.3% vs 0.7%；P < 0.001）。我们机构的大多数 cN0 PTC 患者没有接受 CND。该数据表明 CND 与短期随访期间肿瘤学结果的改善无关，并导致术后发病率增加。因此，我们得出结论，cN0 PTC 患者不应常规进行 CND。
Central neck dissection (CND) remains a controversial intervention for papillary thyroid carcinoma (PTC) patients with clinically negative nodes (cN0) in the central compartment. Proponents state that CND in cN0 patients prevents locoregional recurrence, while opponents deem that the risks of complications outweigh any potential benefit. Thus, there remains conflicting results amongst studies assessing oncologic and surgical outcomes in cN0 PTC patients who undergo CND. To provide clarity to this controversy, we sought to evaluate the efficacy, safety, and oncologic impact of CND in cN0 PTC patients at our institution. Six hundred and ninety-five patients with PTC who underwent thyroidectomy at our institution between 1998 and 2018 were identified using an institutional cancer registry and supplemental electronic medical record queries. Patients were stratified by whether or not they underwent CND; identified as CND(+) or CND(−), respectively. Patients were also stratified by whether or not they received adjuvant radioactive iodine (RAI) therapy. Patient demographics, pathologic results, as well as surgical and oncologic outcomes were reviewed. Standard statistical analyses were performed using ANOVA and/or t-test and chi-squared tests as appropriate. Among the 695 patients with PTC, 492 (70.8%) had clinically and radiographically node negative disease (cN0). The mean age was 50 ± 1 years old and 368 (74.8%) were female. Of those with cN0 PTC, 61 patients (12.4%) underwent CND. CND(+) patients were found to have higher preoperative thyroid stimulating hormone (TSH) values, 2.8 ± 0.8 versus 1.5 ± 0.2 mU/L (P = 0.028) compared to CND(−) patients. CND did not significantly decrease disease recurrence, development of distant metastatic disease (P = 0.105) or persistence of disease (P = 0.069) at time of mean follow-up of 38 ± 3 months compared to CND(−) patients. However, surgical morbidity rates were significantly higher in CND(+) patients; including transient hypocalcemia (36.1% versus 14.4%; P < 0.001), transient recurrent laryngeal nerve (RLN) injury (19.7% vers us 7.0%; P < 0.001), and permanent RLN injury (3.3% versus 0.7%; P < 0.001). The majority of patients at our institution with cN0 PTC did not undergo CND. This data suggests that CND was not associated with improvements in oncologic outcomes during the short-term follow-up period and led to increased postoperative morbidity. Therefore, we conclude that CND should not be routinely performed for patients with cN0 PTC.
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