纳米碳对cN1b期甲状腺乳头状癌的手术效果与预后的影响

Impact of carbon nanoparticle injecting during surgery for cN1b stage papillary thyroid carcinoma operative effect and prognosis

目的目前研究普遍认为纳米碳对cN0期甲状腺乳头状癌手术有促进作用,而对c N1b期乳头状癌的作用仍不明。该研究探讨纳米碳在c N1b期乳头状癌手术中的应用。方法回顾香港大学深圳医院2017年1月至2019年6月收治侧颈淋巴转移(cN1b期)的甲状腺乳头状癌连续病人142例,手术方式为全甲状腺切除加侧颈淋巴结清扫术。其中77例术中注射纳米碳(纳米碳组),65例未注射(对照组)。对比分析术后侧颈淋巴结检出总数、转移数,术后放射碘治疗前血清刺激性甲状腺球蛋白(Tg),放射碘治疗后非刺激性Tg,术后甲状旁腺激素(PTH)、血钙等。结果纳米碳组与对照组手术时间无显著统计学差异(149±35 min vs.153±39 min,P=0.687),侧颈淋巴结检出总数两组无显著统计学差异(22.1±10.0 vs.21.1±10.7,P=0.583),转移淋巴结数同样无显著统计学差异(4.3±3.1 vs.4.0±3.7,P=0.574)。然而纳米碳组术后刺激性Tg显著高于对照组(2.59 ng/mL vs.0.67 ng/mL,P=0.046),放射碘治疗后抑制性Tg两组则无显著统计学差异(0.1 ng/mL vs.0.1 ng/mL,P=0.205)。纳米碳组术后第一天PTH显著低于对照组(8.1 pmol/L vs.13.6 pmol/L,P=0.044),而术后6个月甲状旁腺功能减退率则无统计学差异。结论术中注射纳米碳对c N1b期甲状腺乳头状侧颈淋巴结检出量、术后肿瘤指标均无改善作用,反而对术后短期甲状旁腺功能有潜在危害。c N1b期乳头状癌术中是否使用纳米碳应慎重考虑。

Objective Current studies generally support that intraoperatively injecting carbon nanoparticle(CNP)not only preserves parathyroid function but also improves neck dissection for c N0 stage papillary thyroid carcinoma(PTC). However,impact of using CNP for cN1b stage PTC is still unknown. This study explored utility of CNP during therapeutic neck dissection and evaluation of oncology outcomes. Methods From Jan. 2017 to Jun. 2019,142 consecutive cN1b PTC patients from the University of Hong Kong Shenzhen Hospital were recruited. All the patients underwent total thyroidectomy and compartmental neck dissection. Seventy-seven were injected CNP intraoperatively(CNP group)while 65 were operated without CNP(control group). Study endpoints included number of total and metastatic lateral lymph node,postoperative stimulated thyroglobulin(Tg)before radioactive iodine(RAI)ablation,nonstimulated Tg after RAI,postoperative parathyroid hormone(PTH),calcium. Results Demographics and operative time were comparable between the two groups. There was no significance for number of both total and metastatic lateral lymph node retrieved(22.13±9.95 vs. 21.10±10.69,P=0.583 and 4.29±3.12 vs. 3.96±3.69,P=0.574,respectively). However,postoperative stimulated Tg was significantly higher in CNP group(2.59 ng/mL vs. 0.67 ng/mL,P=0.046),while there was no significance for post-RAI suppressed Tg between the two groups(0.1 ng/mL vs. 0.1 ng/mL,P=0.205). Postoperative Day 1 PTH was significantly lower in CNP group(8.1 pmol/L vs. 13.6 pmol/L,P=0.044). Morbidity of post 6 month hypoparathyroidism has no significance between two groups. Conclusion Intraoperative injecting CNP may not facilitate lateral neck dissection and postoperative Tg level for cN1b PTC. Conversely,it has potential harm to postoperative short-term parathyroid function. Using CNP should be taken into consideration cautiously for cN1b PTC.