Identifying risk factors of lateral lymph node recurrence in clinically node-negative papillary thyroid cancer
Identifying risk factors of lateral lymph node recurrence in clinically node-negative papillary thyroid cancer
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DOI：
10.1097/md.0000000000013435
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发表时间：
2018-12-01
期刊：
影响因子：
1.6
通讯作者：
Park, Min Ho
中科院分区：
文献类型：
--
作者：
Ryu, Young Jae;Kang, Shin Jae;Park, Min Ho
关于常规中央淋巴结（LN）清扫术在治疗临床淋巴结阴性甲状腺乳头状癌（PTC）中的作用仍存在争议。本研究旨在探讨临床淋巴结阴性PTC患者行甲状腺全切除术和预防性双侧中央淋巴结清扫术后侧方复发的危险因素。我们回顾性收集了2004年1月至2008年12月期间接受甲状腺全切除术和预防性双侧中央淋巴结清扫术的1406例PTC患者的病历。我们采用Cox比例风险回归分析来检验复发的预测因素。 107 个月（范围：13-164 个月）、68 名（4.8%）和 37 名（2.6%）患者的任何病灶和侧颈淋巴结复发分别发生。单变量分析显示，男性、主要肿瘤大小 > 1 cm、淋巴结因素（病理性 N1a、德尔菲式 LN 阳性和 LN 比率 >0.15）、淋巴管侵犯和甲状腺外扩展 (ETE) 与颈侧 LN 复发显着相关。多变量分析显示，男性（风险比[HR]，2.217；95%置信区间[CI]，1.057-4.647；P = .035），主要肿瘤大小>1cm（HR.2.257；95% CI，1.138-4.476；P = .020），病理N1a（HR，5.957；P = .020）。 95% CI，2.573-13.789；P < .002），轻微 ETE（与无 ETE 相比；HR，3.027：95% CI，1.315-6.966；P = .009）。和总 ETE（与无 ETE 相比；HR，4.058：95% CI，1.685-9.774；P = .002）是侧颈 LN 复发的独立预测因子。在病理性 N1a 患者中，LN 比率超过 0.55 的患者侧颈 LN 无复发生存率较差。临床淋巴结阴性 PTC 患者的颈侧淋巴结复发由男性、主要肿瘤大小 >1 cm、ETE 和病理 N1a 等因素预测。
There is still debate regarding the role of routine central lymph node (LN) dissection in treating clinically node-negative papillary thyroid cancer (PTC). The aim of this study was to investigate the risk factors for lateral recurrence after total thyroidectomy and prophylactic bilateral central LN dissection in clinically node-negative PTC patients.We retrospectively collected the medical records of 1406 PTC patients who underwent total thyroidectomy and prophylactic bilateral central LN dissection between January 2004 and December 2008. We used Cox-proportional hazards regression analyses to inspect the predictive factors for recurrence.During a median follow-up of 107 months (range, 13-164 months), 68 (4.8%) and 37 (2.6%) patients experienced recurrence in any lesion and in lateral neck LN, respectively. Male, main tumor size > 1 cm, nodal factors (pathologic N1a, positive delphian LN, and LN ratio >0.15), lymphovascular invasion, and extrathyroidal extension (ETE) were significantly associated with lateral neck LN recurrence in univariate analysis. Multivariate analysis showed that male (hazard ratio [HR], 2.217; 95 % confidence interval [CI], 1.057-4.647; P = .035), main tumor size >1cm (HR. 2.257; 95% CI, 1.138-4.476; P = .020), pathologic N1a (HR, 5.957; 95% CI, 2.573-13.789; P < .002), minor ETE (vs no ETE; HR, 3.027: 95% CI, 1.315-6.966; P = .009). and gross ETE (vs no ETE; HR, 4.058: 95% CI, 1.685-9.774; P = .002) were independent predictors for lateral neck LN recurrence.Among patients with pathologic N1a, those with LN ratio of more than 0.55 had worse lateral neck LN recurrence-free survival. Lateral neck LN recurrence in clinically node-negative PTC patients is predicted by the factors of male, main tumor size >1 cm, ETE, and pathologic N1a.