甲状腺癌颈部中央区淋巴结转移对侧区的影响

Value of cervical central lymph node metastasis of thyroid cancer in prediction of contralateral region lymph node metastasis

目的探讨颈部中央区淋巴结转移对甲状腺乳头状癌手术患者颈部侧区淋巴结转移的影响。方法选取2012年4月-2015年2月该院收治的甲状腺乳头状癌患者90例,依据颈部中央区淋巴结转移情况分为转移组和无转移组。根据中央区淋巴结数量将转移组患者分为3组,A组(淋巴结转移数=1个)27例,B组(淋巴结转移数=2个)14例,C组(淋巴结转移数≥3个)24例。比较转移组和无转移组患者的临床资料,记录A、B、C 3组患者颈部侧区淋巴结转移情况,计算颈部中央区淋巴结转移在侧区淋巴结转移预测方面的敏感性和阳性预测值。结果转移组和无转移组患者的年龄、性别、颈部侧区淋巴结转移率比较,差异有统计学意义(P<0.05),其中转移组颈部侧区淋巴结转移率明显高于无转移组(P<0.05)。转移组患者65例,其中A组27例,B组14例,C组24例,3组患者颈部侧区淋巴结转移率分别为51.85%、71.43%和83.33%。颈部中央区淋巴结转移65例,颈部侧区淋巴结转移51例,颈部中央区淋巴结转移在侧区淋巴结转移预测方面的敏感性为96.08%,阳性预测值为75.38%。结论甲状腺乳头状癌手术患者的颈部中央区淋巴结转移数越多,颈部侧区淋巴结转移风险越高,术中可根据中央区淋巴结转移情况选择侧区淋巴结清扫术,预防颈部侧区淋巴结转移。

Objective To investigate the effect of central neck lymph node metastasis of papillary thyroid carcinoma patients on lateral neck region lymph node metastasis. Methods Ninety cases with papillary thyroid cancer in our hospital from April 2012 to February 2015 were divided into metastasis group（65 cases） and non-metastasis group（25 cases） according to the central neck lymph node metastasis. According to the number of cervical central metastatic lymph nodes, the metastasis group was further divided into 3 groups, i.e.group A（n = 1, 27 cases）, group B（n = 2, 14 cases） and group C（n ≥ 3, 24 cases）. The clinical data of metastasis group and non-metastasis group were compared. Lateral neck lymph node metastasis was recorded in the groups A, B and C. The sensitivity of central neck lymph node metastasis in prediction of lateral lymph node metastasis and the positive predictive value were calculated. Results The age, gender and metastasis rate of the patients in the metastasis group were significantly different from those of the non-metastasis group（P〈 0.05）, and the metastasis rate of the lateral lymph nodes in the metastasis group was significantly higher than that in the non-metastasis group（P〈 0.05）. In the 65 patients with central lymph node metastasis, 51 cases had lateral lymph node metastasis. The rate of lateral lymph node metastasis in the groups A. B and C was 51.85%, 71.43% and 83.33% respectively. The sensitivity of central neck lymph node metastasis in prediction of lateral lymph node metastasis was 96.08%, the positive predictive value was 75.38%. Conclusions In thyroid papillary carcinoma patients, the larger the number of central neck metastatic lymph node, the higher the risk of lateral neck lymph node metastasis. Operation of lateral lymph node dissection can be made according to central neck lymph node metastasis to prevent the lateral neck lymph node metastasis.