何伟, 苏新良, 吴凯南, 周静, 胡代星, 曹宜嘉, 毛雨, 任浩宇. cN0 甲状腺乳头状癌对侧中央区淋巴结转移相关 因素的探讨[J]. 中国肿瘤临床, 2017, 44(1): 41-45. DOI: 10.3969/j.issn.1000-8179.2017.01.193
引用本文: 何伟, 苏新良, 吴凯南, 周静, 胡代星, 曹宜嘉, 毛雨, 任浩宇. cN0 甲状腺乳头状癌对侧中央区淋巴结转移相关 因素的探讨[J]. 中国肿瘤临床, 2017, 44(1): 41-45. DOI: 10.3969/j.issn.1000-8179.2017.01.193
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HE Wei, SU Xinliang, WU Kainan, ZHOU Jing, HU Daixing, CAO Yijia, MAO Yu, REN Haoyu. Factors related to contralateral central lymph node metastasis in clinically node-negative papillary thyroid carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2017, 44(1): 41-45. DOI: 10.3969/j.issn.1000-8179.2017.01.193
Citation: HE Wei, SU Xinliang, WU Kainan, ZHOU Jing, HU Daixing, CAO Yijia, MAO Yu, REN Haoyu. Factors related to contralateral central lymph node metastasis in clinically node-negative papillary thyroid carcinoma[J]. CHINESE JOURNAL OF CLINICAL ONCOLOGY, 2017, 44(1): 41-45. DOI: 10.3969/j.issn.1000-8179.2017.01.193
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cN0 甲状腺乳头状癌对侧中央区淋巴结转移相关 因素的探讨

Factors related to contralateral central lymph node metastasis in clinically node-negative papillary thyroid carcinoma

    摘要
  • 摘要:
      目的  分析 cN0 甲状腺乳头状癌(papillary thyroid carcinoma，PTC) 对侧中央区淋巴结(contralateral central lymph nodes， Cont-CLNs) 转移相关因素，探讨 Cont-CLNs 清扫适应证。
      方法  回顾性分析 2013 年 6 月至 2015 年 12 月就诊于重庆医科大学附属第一医院的单侧 PTC 患者 149 例，均已接受甲状腺全切以及预防性 Cont-CLNs 清扫。分析性别、年龄、肿瘤直径、包膜外侵犯、原发灶数目、是否合并甲状腺炎、喉前淋巴结、Ipsi-CLNs 与 Cont-CLNs 转移的关系。
      结果  本组患者 Ipsi-CLNs 转移率和 Cont-CLNs 转移率分别为 73.2%和 23.5%，其中性别、年龄、肿瘤直径、原发灶数目、是否合并甲状腺炎与 Cont-CLNs 转移均不相关(P=0.792、 0.097、0.531、0.578、0.269、1.000) ，包膜外侵犯(P=0.017) 、喉前淋巴结转移(P=0.006) 和 Ipsi-CLNs 转移(P＜0.001) 与 Cont-CLNs 转移相关。但多因素分析后发现 Ipsi-CLNs 转移数目≥3 枚是 Cont-CLNs 转移的独立危险因素(P=0.010) 。
      结论  包膜外侵犯、喉前淋巴结和 Ipsi-CLNs 是 Cont-CLNs 的影响因素；当 Ipsi-CLNs 转移数目≥3 枚，且合并喉前淋巴结或包膜外侵犯时，可考虑行 Cont-CLNs 清扫。

     

    Abstract:
      Objective   To analyze the factors related to metastasis of contralateral central lymph node (CLN) in cN0 papillary thyroid car-cinoma (PTC) and discuss the indications for CLN dissection.
      Methods   We enrolled 14 9 unilateral PTC patients who underwent total thyroidectomy and prophylactic bilateral (CLN) dissection. This work analyzed the relationship of gender, age, extrathyroidal extension, multifocality, thyroiditis, ipsilateral central lymph nodes, and prelaryngeal lymph node with CLNs.
      Results   The rates of metastasis to ip-silateral and contralateral central compartments were 73.2% and 23.5%, respectively. In univariate analysis, gender, age, tumor size, multifocality, and thyroiditis were not important in predicting contralateral central compartment lymph node metastasis (P=0.792, 0.097, 0.531, 0.269, and 1.000, respectively); by contrast, extrathyroidal extension (P=0.017), prelaryngeal lymph nodes (P=0.006), and ipsilateral CLNs (P＜0.001) are related to CLN metastasis. However, multivariate analysis showed that ipsilateral central metastasis was an independent risk factor for lymph node metastasis in the contralateral central region when the number of ipsilateral central metas-metastases is ≥3 (P=0.010).
      Conclusion   Extracapsular invasion, prelaryngeal lymph nodes, and ipsilateral CLN influence the metastases of CLN. Bilateral CLN dissection should be performed when the number of ipsilateral central metastases is ≥3 and there is merger of extra-laryngeal lymph nodes or capsule invasion.

     

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