喉前淋巴结与甲状腺乳头状癌颈部淋巴结转移的相关性研究

Correlation between delphian lymph node and cervical lymph node metastasis of papillary thyroid carcinoma

目的:探讨在甲状腺乳头状癌(PTC)中,喉前淋巴结(DLN)转移与颈部其他淋巴结转移的相关性。方法:回顾性分析533例行手术治疗且有DLN检出的PTC患者,分为DLN-阳性组(139例)和DLN-阴性组(394例),比较两组患者临床病理特征及颈部淋巴结转移情况。结果:在533例PTC患者中,DLN的转移率为26.08%(139/533),16例仅发生DLN转移而无其他中央区淋巴结转移。单因素分析显示,肿瘤直径>1 cm(P<0.001),多灶(P=0.002),位于中上1/3(P=0.047),临近被膜(P=0.011),中央区(P<0.001)及侧颈淋巴结转移(P<0.001),淋巴脉管浸润(P=0.014),甲状腺外侵犯(P<0.001),高侵袭性病理亚型(P=0.013)与DLN转移有关。多因素分析显示,肿瘤直径>1 cm(OR=0.466,P=0.001),位于中上1/3(OR=1.748,P=0.024),中央区(OR=0.180,P<0.001)及侧颈淋巴结转移(OR=0.468,P=0.003)和淋巴脉管浸润(OR=0.294,P=0.005)是DLN转移的独立危险因素。DLN阳性患者同侧及对侧中央区淋巴结转移率和侧颈淋巴结转移率更高(P<0.05),且有更多的淋巴结转移数目(P<0.05)。结论:PTC术中应规范清扫喉前及锥状叶周围的淋巴及软组织,对于DLN转移,尤其高侵袭亚型者,建议行全甲状腺切除及双侧中央区淋巴结清扫,必要时选择性侧颈淋巴结清扫。

Objective:To explore the correlation between delphian lymph node(DLN)metastasis and cervical lymph node metastasis in papillary thyroid carcinoma(PTC).Methods:A total of 533 PTC patients with DLN detection after surgical treatment were retrospectively analyzed,divided into DLN-positive(139 cases)and DLN-negative(394 cases)groups.Clinicopathological factors and cervical lymph nodes metastases were compared between the two groups.Results:Among the 533 PTC patients with DLN detected,139 patients had DLN metastasis,with a DLN metastasis rate of 26.08%(139/533),and 16 patients only had DLN metastasis without other central lymph node metastasis(CLNM).Univariate analysis showed that the tumor diameter>1 cm(P<0.001),multifocality(P=0.002),location in the upper 1/3(P=0.047)and close to capsule(P=0.011),CLNM(P<0.001)and lateral lymph node metastasis(LLNM)(P<0.001),lymphovascular invasion(P=0.014),extrathyroidal extension(P<0.001),and aggressive pathological variants(P=0.013)were related to DLN metastasis.Multivariate analysis showed that the tumor diameter>1 cm(OR=0.466,P=0.001),location in upper 1/3(OR=1.748,P=0.024),CLNM(OR=0.180,P<0.001)and LLNM(OR=0.468,P=0.003)and lymphovascular invasion(OR=0.294,P=0.005)were independent risk factors for DLN metastasis.The incidence of ipsilateral or contralateral CLNM and LLNM was higher in patients with DLN metastasis(P<0.05),with a larger number of lymph nodes metastases(P<0.05).Conclusion:During PTC operation,lymph and soft tissue in the prelaryngeal region and around the cone lobes should be dissected in a standard manner.For patients with DLN metastasis,especially those with aggressive pathological variants,total thyroidectomy and bilateral central lymph node dissection(CLND)are recommended,and selective lateral lymph node dissection(LLND)should be performed if necessary.