cN0期甲状腺乳头状癌侧颈淋巴结转移影响因素分析

Analysis of factors for lateral neck lymph node metastasis in cNO papillary thyroid carcinoma

目的本研究旨在探索oN0期PTC侧颈淋巴结转移规律，初步探讨预防性侧颈淋巴结清扫的必要性。方法回顾性分析2012年1月至2015年5月郑州大学附属肿瘤医院甲状腺头颈外科收治的651例eN0期明C患者临床资料，用r检验对盯C侧颈淋巴结转移的相关因素作单因素分析。结果651例cN0期PTC患者颈部淋巴结总转移率62．9％（中央区51-3％，侧颈区41．0％，“跳跃性”转移11．7％）。侧颈转移率为：男性与女性（50．9％VS37．7％，P=8．821，P〈0．05），肿瘤直径〉1．0cm与≤1．0cm（61．9％V825．9％，P=84．818，P〈0．001），多灶癌与单灶癌（47．2％VS40．3％，P=6．588，P〈0．05），包膜及腺外侵犯与包膜内（63．1％V834．3％，P=40．194，P〈0．001），中央区淋巴结转移数目≥3枚与〈3枚（64．1％VS48_3％，P=8．309，P〈0．05），上极癌灶与其他位置（52．4％V832．9％，P=18．377，P〈0．001），年龄≤45岁与〉45岁（41．O％VS40．9％，P=0．001，P〉0．05）。结论eN0期PTC患者应常规清扫患侧中央区淋巴结，对于男性、肿瘤直径〉1．0cm、多灶癌、包膜及腺外侵犯、中央区淋巴结转移数目≥3枚、癌灶位于腺体上极的患者应积极行预防性侧颈淋巴结清扫。

Objective To explore the lateral neck lymph node metastasis （LNM） in patients affected by papillary thyroid carcinoma（PTC） with clinically negative neck （cN0-PTC） and to discuss the necessity of pro- phylactic lateral neck lymph node dissection. Methods Clinical data of 651 cN0-PTC patients who underwnt surgical procedure in Tumor Hospital of Zhengzhou University from Jan. 2012 to May. 2015 were retrospectively analyzed. Chi-square test was used for univariate analysis. Results Of the 651 cN0-PTC patients, 62.9% had LNM （51.3% in central neck, 41.0% in lateral neck, and 11.7% with ＂skip＂ metastasis）. The lateral neck metastasis rate was 50.9% in men and 37.7% in women （P〈0.05）, 61.9% in patients with tumor diameter 〉1.0 cm and 25.9% in patients with tumor diameter ≤1.0 cm （P〈O.001）, 47.2% with muhifocal cancer and 40.3% with unifoeal tumor（P〈 0.05）, 63.1% with extrathyroidal extention and 34.3% without extention （P〈0.O01）, 64.1% with ≥3 positive nodes in central neck and 48.3% with 〈3 positive nodes （P〈O.05） ,52.4% with upper lobe cancer and 32.9% with other loca- tions（P〈0.001）, 41.0% in patients ≤45 years and 40.9% in patients 〉45 years（P〉0.05）. Conclusion Central neck dissection should be performed in all cN0-PTC patients. Prophylactic lateral neck dissection should bese- lectively performed in cN0-PTC patients with following high-risk factors： male, tumor diameter 〉1.0 cm, multifo- cal cancer, extrathyroidal extention, 1〉3 positive nodes in central neck and upper lobe cancer.