预防性中央区淋巴结清扫与甲状腺乳头状癌局部复发的Meta分析

目的:探讨预防性中央区淋巴结清扫(pCND)能否降低甲状腺乳头状癌术后的局部复发.方法:计算机检索国内外数据库中自2001年1月-2012年12月公开发表的有关甲状腺全切加pCND对比单纯甲状腺全切治疗甲状腺乳头状癌研究的文献,提取数据,行Meta分析.结果:最终纳入10个研究,共2 272例患者,其中甲状腺全切加pCND组897例,甲状腺全切组1 375例.Meta分析结果显示,甲状腺全切加pCND组较单纯甲状腺全切术组的总复发率(OR=0.73,95％ CI=0.49-1.07,P=0.11),中央区复发率(OR=0.92,95％ CI=0.33-2.51,P=0.86)及颈侧区复发率(OR=1.00,95％ CI=0.50-2.00,P=0.99)均无明显改善.结论:对于颈部淋巴结阴性(cNo)的甲状腺乳头状癌患者,预防性中央区淋巴结清扫不能减少术后复发率.

Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a Meta-analysis

Objective: To evaluate whether prophylactic central neck dissection (pCND) can decrease the local recurrence rate of papillary thyroid cancer (PTC) after thyroidectomy.Methods: The publicly available literature published from January 2001 to December 2012 concerning total thyroidectomy plus pCND versus total thyroidectomy alone for PTC was retrieved by searching the national and international online databases. Meta-analysis was performed after the data extraction process.Results: Ten studies were finally included with a total of 2 272 patients, of whom, 897 cases underwent total thyroidectomy plus pCND and 1 375 cases received total thyroidectomy only. As shown by the Meta-analysis results, no significant improvements were seen in total thyroidectomy plus pCND compared with thyroidectomy alone group in respects to the overall recurrence rate (OR=0.73, 95% CI=0.49?1.07, P=0.11), and recurrence rates in the central (OR=0.92, 95% CI=0.33?2.51, P=0.86) and lateral neck (OR=1.00, 95% CI=0.50?2.00, P=0.99). Conclusion: For patients with clinically node negative (cN0) PTC, pCND cannot reduce the postoperative recurrence rate.