右喉返神经后方淋巴结清扫在甲状腺乳头状癌中的临床研究

Clinical research of the lymph node dissection posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)右喉返神经后方淋巴结(LN-pr RLN,右颈VI-2亚区)清扫的临床价值。方法选取2014~2015年收治的右侧或双侧PTC患者408例,采用单因素分析及多因素Logistic回归分析研究LN-pr RLN转移与患者各项临床病理特征的关系,ROC曲线分析其预测价值。结果 408例PTC右颈VI区淋巴结转移率为49.02%,其中右VI-1亚区(右颈中央浅层)为46.32%,右VI-2亚区为16.67%。单因素分析右VI-2转移与性别、年龄、右侧癌灶大小及数目、被膜侵犯、右VI-1转移及转移灶大小、右颈侧区淋巴结转移有关(P均<0.05)。多因素分析显示,右VI-2转移与右侧癌灶大小、被膜侵犯、右颈VI-1转移、右颈侧区淋巴结转移相关(P均<0.05)。ROC显示:年龄<35.5岁、右侧癌灶>0.85 cm、右颈VI-1亚区转移淋巴结>1.5个、右颈VI-1亚区淋巴结转移灶>0.45 cm、右颈侧区转移淋巴结>0.5个来预测LN-pr RLN转移的AUC值分别为0.585、0.787、0.788、0.725、0.719。结论当患者是男性、年龄<35.5岁、右侧癌灶>0.85 cm、被膜侵犯、右颈VI-1亚区转移淋巴结>1.5个、右颈VI-1亚区淋巴结转移灶>0.45 cm、右颈侧区转移淋巴结>0.5个时,需常规行LN-pr RLN清扫。

OBJECTIVE To investigate the clinical value of the lymph nodes posterior to the right recurrent laryngeal nerve （LN-prRLN, right VI-2） dissection in papillary thyroid carcinoma （PTC）. METHODS We studied the relationships between LN-prRLN metastasis and the clinicopathological characteristics in 408 patients with right or bilateral PTC who underwent LN-prRLN dissection. RESULTS Right VI-2 lymph node metastasis was 16.67%. Single factor analysis showed that there were statistically significant correlations between right VI-2 metastasis and gender, age,size and number of right thyroid lobe tumor, capsular invasion, right VI-1 lymph node metastasis and their size,and also metastatic lymph node in the right cervical lateral compartment. Multivariate Logistic regression analysis showed that Right VI-2 lymph node metastasis was related to right tumor size, capsular invasion, the right VI-1 metastasis and right lateral lymph node metastasis（P〈0.05）. The receiver-operator characteristic （ROC） analysis showed that the risk factors of LN-prRLN： age 〈35.5 years, right tumor size 〉0.85 cm, lymph node （right VI-1） number 〉1.5, metastatic lymph node （right VI-1） size 〉0.45 cm, lymph node number in the right cervical lateral compartment 〉0.5 and the areas under the ROC curves were 0.585, 0.787, 0.788, 0.725, 0.719. CONCLUSION The dissection of LN-prRLN should be considered when patient with the risk factors such as male, age 〈35.5 years, right tumor size 〉0.85 cm, capsular invasion, lymph node （right VI-1） number 〉1.5, metastatic lymph node （right VI-1） size 〉0.45 cm, lymph node number in the right cervical lateral compartment 〉0.5.