cN0甲状腺乳头状癌中央区淋巴结阳性与侧区淋巴结转移的关系

The relationship between the central cervical lymph node metastasis and the lateral cervical lymph node metastasis in cN0 papillary thyroid cancer

目的 探讨甲状腺乳头状癌中央区淋巴结阳性与侧区淋巴结的关系.方法 回顾性分析首都医科大学附属北京友谊医院2009年1月至2012年12月行预防性颈淋巴结清扫的50例甲状腺乳头状癌资料.女36例,男14例.结果 根据患者中央区淋巴结阳性数目分为3组：中央区淋巴结转移数=1（A组,n =21）,中央区淋巴结转移数=2（B组,n=11）,中央区淋巴结转移数≥3（C组,n=18）,各组相应侧区淋巴结受累的风险分别为47.5％、81.8％、88.9％ （P =0.012）.单因素分析提示T3～4及中央区淋巴结阳性数≥2枚是侧区淋巴结转移的危险因素.多因素分析提示中央区淋巴结阳性数≥2枚是独立的危险因素（OR 4.67,95％ CI1 ～22）,阳性预测值为86.2％.结论 T3～4或中央区淋巴结阳性数量≥2枚是PTC侧区淋巴结转移的高危因素,可考虑行预防性颈部淋巴结清扫.

Objective To analyze the relationship between central cervical lymph node metastasis and the lateral cervical lymph node metastasis in cN0 papillary thyroid cancer.Methods We retrogradely analyze 50 cases of papillary thyroid cancer who had prophylactic modified neck dissection in recent three years.There were 36 females and 14 males patients.Patients were divided into three groups according to the number of positive CCLN：groupA=1（n=21）; B=2（n=11） andC≥3（n=18）.Results The risk of lateral compartment lymph nodes involvement increased in parallel with the number of positive CCLN（47.5％ vs.81.8％ vs.88.9％ in groups A,B and C,respectively; P =0.012）.Univariate analysis revealed the number of CCLN ≥ 2 （P =0.04）,T3-4 （P =0.049） were risk factors for the metastasis in the lateral neck.However,multi-variate analysis implied only the C CLN ≥ 2 was the independent factor（OR 4.67,95 ％ CI 1 ～22）,with a positive predictive value 86.2％.Conclusion T3-4 and positive CCLN ≥ 2 are risk factors for lateral compartment involvement in cN0 PTC,prophylactic modified neck dissection can be considered.