甲状腺乳头状微小癌预后因素及手术范围的Meta分析

Meta analysis of prognostic factors and surgical extent of papillary thyroid microcarcinoma

目的研究甲状腺乳头状微小癌（PTMC）的预后因素及手术范围。方法检索PTMC的相关研究，通过Meta分析判断多种因素与首次术后复发的关系，对PTMC的手术范围进行探讨。结果共纳入12篇回顾性研究，Meta分析结果显示PTMC首次术后复发与男性、肿瘤直径〉5mm、非附带、术前诊断淋巴结阳性、多发病灶、侵及包膜等因素相关，与年龄≥45岁无关。预防性颈部淋巴结清扫组与未行颈部淋巴结清扫组之间首次术后复发率差异无统计学意义。结论PTMC的预后与多因素相关，应根据预后因素选择腺叶切除范围，预防性颈部淋巴结清扫不应作为PTMC的常规术式，术前诊断淋巴结阳性的患者可行双侧中央区淋巴结清扫术。

Objective To study prognostic factors and surgical extent of papillary thyroid microcarcinoma （PTMC）. Methods Literatures about PTMC were searched. Relationship between prognostic factors and recurrence after initial operation was analyzed by meta analysis. The surgical extent of PTMC was discussed. Results A total of 12 retrospective studies were included. Mcta analysis results showed that factors such as male, tumor size 〉 5 mm, nonineidental, positive lymphnode, multifocus, and capsular invasion were related to recurrence after initial surgery. Age above 45 years had nothing to do with the recurrence rate of PTMC. There was no significant difference in recurrence rate between prophylactic neck dissection groups and the groups without prophylactic neck dissection. Conclusions Many factors are related to the prognosis of PTMC. The surgical extent depends on prognostic factors. Prophylactic neck dissection is not supposed to be conventional surgical procedure for PTMC. Bilateral central lymph node dissection is appropriate to PTMC with positive lymph node.