cN1b甲状腺乳头状癌Ⅱb区淋巴结转移特点及相关因素探索

Pattern and predictive factors of LevelⅡb lymph nodes metastasis in patients with cN1b papillary thyroid carcinoma

目的探讨颈侧区转移(cN1b)甲状腺乳头状癌Ⅱb区淋巴结转移特点及其相关因素。方法回顾性分析2007年6月至2011年6月在汕头大学医学院附属肿瘤医院接受治疗性颈清扫(Ⅱ～Ⅴ区)的cN1b甲状腺乳头状癌患者的临床资料,共83例,颈清扫淋巴结标本按颈部分区(Ⅱa、Ⅱb、Ⅲ、Ⅳ、Ⅴ)收集并送术后常规病理检查。结果 83例中,Ⅱ、Ⅲ、Ⅳ及Ⅴ区淋巴结转移率分别为54.2%(45/83)、69.9%(58/83)、73.5%(61/83)和15.7%(13/83),Ⅱa区和Ⅱb区淋巴结转移率分别为51.8%(43/83)和14.5%(12/83)。多因素分析显示Ⅱa～Ⅳ区同时转移与否是Ⅱb区淋巴结转移的独立影响因素(37.5%vs.5.1%,OR=10.8,P=0.032)。结论甲状腺乳头状癌Ⅱb区淋巴结转移率低,术中冰冻或术前CT提示Ⅱa～Ⅳ区非同时阳性时,cN1b甲状腺乳头状癌患者无需常规行Ⅱb区清扫。

Objective To evaluate the frequency and pattern of level lib lymph nodes （LNs） metastasis and identify the risk factors for level Hb LNs in papillary thyroid carcinoma（ PTC ） patients with positive lateral neck LNs. Methods We retrospectively reviewed the medical records between June 2007 and June 2011 of 83 patients with PTC who underwent therapeutic lateral neck dissections （level II - V ）. Neck dissection specimens were obtained for histologic analysis for node metastasis with respect to the individual neck levels. Results 45 （54.2%）, 58 （69.9%）, 61 （73.5%） and 13 （ 15.7% ） patients had histologically positive lymph nodes in levels II , III, IV and V, respectively. Metastases in level IIa and lib were observed in 43（51.8% ） and 12 （ 14.5% ） patients, respectively. In multivariate analysis, simultaneous multilevel involvement （level IIa, III, and IV） of lymphatic metastases was associated with level lib metastasis （37.5% vs. 5.1% , OR = 10.8, P = 0. 032）. Conclusions Lymphatic metastases are not common in level lib in PTC patients, Level IIb lymphadeneetomy may be omitted if simultaneous multilevel involvement （ level IIa, III, and IV ） of lymphatic metastases are not found by pathology or CT scan.