中央区浅层淋巴结与甲状腺乳头状癌右喉返神经后方淋巴结的相关研究

Clinical research about level VI-1 lymph nodes and the lymph nodes posterior to the right recurrent laryngeal nerve of the papillary thyroid carcinoma

目的自右颈中央区浅层(右颈Ⅵ-1区)淋巴结转移情况探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者何时需行右喉返神经后方淋巴结(lymph node behind the right recurrent laryngeal nerve,LN-prRLN)清扫术。方法自2014年3月~2015年9月杭州市第一人民医院集团306例右侧或双侧PTC患者,分析右颈Ⅵ-1区淋巴结转移情况、转移个数、转移灶大小对LNprRLN转移的预测价值。结果右颈Ⅵ-1区淋巴结转移个数以及转移灶大小对于预测LN-prRLN转移有统计学差异,当右颈Ⅵ-1区淋巴结转移个数为1.5个,其敏感度及特异度分别为78.43%及76.65%,其曲线下面积(area under curve,AUC)值为0.813;当右颈Ⅵ-1区淋巴结转移灶大小为0.45 cm时,其敏感度为90.20%,特异度为48.90%,其AUC值为0.726,具有诊断价值。结论双侧或右侧PTC患者,当右颈Ⅵ-1区淋巴结转移个数≥2个且转移灶>0.45 cm时,需行LN-prRLN清扫。

OBJECTIVE The objective of this study is to discuss when to dissect the lymph nodes behind the right recurrent laryngeal nerve （LN-prRLN） from the standpoint of the right cervical level VI-1 （superficial layer to the recurrent laryngeal nerve） lymph nodes in papillary thyroid carcinoma （PTC） patients. METHODS The clinical data of 306 bilateral or right PTC patients from the Hangzhou First People＇s Hospital who underwent dissection of level VI-1 lymph nodes and LN-prRLN between March 2014 and September 2015 were analyzed. We measured the number of level VI-1 metastatic lymph nodes and size of level VI-1 lymph nodes metastasis loci to predict the metastasis of LN-prRLN. RESULTS The number of level VI-1 metastatic lymph nodes and size of level VI-1 lymph nodes metastasis loci were risk factors of LN-prRLN metastasis（P〈0.05）. When the number of the level VI-1 metastatic lymph nodes was greater than 1.5, the AUC was 0.813 （the sensitivity was 78.43%, the specificity was 76.65%）. The ROC showed that when the size of level VI-1 lymph nodes metastasis loci were more than 0.45 cm, the AUC was 0.726 （sensitivity was 90.20%, specificity was 48.90%）. CONCLUSION In bilateral or right PTC patients with metastasis of level VI-1 lymph nodes, especially when the number of level VI-1 metastatic lymph nodes was greater than 2cm and the metastasis loci were more than 0.45 cm, we should dissect the LN-prRLN.