乳头状甲状腺癌侧颈淋巴结隐匿性转移相关因素分析

Clinical and pathological predictors of occult lateral neck lymph lode metastases in patients with papillary thyroid cancer

目的分析cN0乳头状甲状腺癌(PTC)行选择性颈淋巴结清扫的结果,研究不同临床病理特征对侧颈隐匿性淋巴结转移的影响。方法回顾性分析2008年1月至2011年3月109例我院行选择性颈淋巴结(包括同侧颈淋巴结)清扫的cN0期PTC患者资料,对其术后侧颈隐匿性淋巴结转移率与各临床病理特征的相关性进行分析。结果所有cN0病例中,Ⅵ区隐匿性转移率为46.8%,侧颈淋巴结隐匿性转移率为33.9%。淋巴结转移相关的因素有原发肿瘤大小(超声长径或病理长径)、腺外组织侵犯,侧颈淋巴结超声特点(包括淋巴门消失、皮髓质结构不清、血流丰富)及Ⅵ区淋巴结转移,同淋巴结阴性组差异具有统计学意义(P<0.05)。结论选择性颈淋巴结清扫后发现cN0期PTC患者存在一定的侧颈淋巴结隐匿性转移率,转移的概率与以上临床病理因素相关,对具有高危因素的患者建议行选择性淋巴结清扫术。

Objective To identify clinical and pathological predictors of occult lateral neck lymph node （LN） metastases by analyzing the results of cN0 papillary thyroid cancer（PTC） patients who were conducted selective neck dissection, rllethods Total 109 cases of cN0 PTC patients underwent selective cervical dissection （ including ipsilateral neck dissection）between January 2008 and March 2011 were reviewed. Clinical factors and tumor ultrasound characteristics were recorded. The final pathology results were recorded too, and correlations between clinic and pathologic characteristics and occult lateral neck LN metastasis rate were analyzed. Results Of the 109 cN0 stage cases,51 （46. 8% ）had positive nodes in the central neck;37 （33.9%）had positive nodes in the ipsilateral neck. The factors significantly associated with occult lateral neck LN metastases were primary tumor size （ ultrasonic diameter or pathological diameter）, extrathyroidal extension, ultrasonic characteristics of lateral cervical LN（including the loss of hilum, eccentric cortical widening, hypervascularized）, and metastasis to central compartment （ P 〈 0. 05 ）. Conclusions Considerable rate of lateral occult LN metastasis can be discovered after selective neck dissection in patients with PTC. The clinical and pathological factors described above were found to have a statistically significant association with the rate of occult metastasis. Selective LN dissection could be recommended in patients with these high risk factors.