双侧甲状腺乳头状癌中央区隐匿转移相关因素分析

目的：探索双侧甲状腺乳头状癌（PTC）中央区隐匿转移的规律。方法对收治的56例中央区临床阴性（cN0期）的双侧PTC患者常规行中央区清扫，回顾性分析术后病理中央区转移的相关因素。结果全组患者中央区转移率为64.3%（36/56），其中单侧中央区转移率为25.0%（14/56），双侧转移率为39.3%（22/56）。在可区分轻重侧的33例患者中，无转移，双侧转移，仅轻侧转移和仅重侧转移比例分别为33.3%、39.4%、9.1%和18.2%，轻、重侧总转移概率分别为48.5%和57.6%，差异无统计学意义（χ2=0.547，P=0.459）。最大肿瘤直径﹥1 cm和颈侧转移是中央区隐匿转移的影响因素；以单侧病变为对象分析，肿瘤浸润包膜和侧颈转移是该侧中央区隐匿转移的独立危险因素。结论双侧PTC患者具有较为特殊的中央区转移规律且隐匿转移发生率较高，在情况允许下可考虑进行双侧中央区清扫。

Study on the occult central compartment lymph node metastasis of bilateral thyroid papillary carcinoma

Objective To explore the pattern of occult central compartment lymph node metastasis of bilateral papil-lary thyroid carcinoma (PTC). Method Routine bilateral central compartment neck dissection was performed in 56 cases with bilateral PTC at stage cN0, and postoperative pathology was analyzed. Result The overall rate of central compart-ment lymph node metastasis was 64.3%(36/56), in which the unilateral and bilateral metastasis rate was 25.0%(14/56) and 39.3%(22/56), respectively. Of the 33 cases who had different bilateral lesions, the rate of no metastasis, bilateral me-tastasis, unilateral metastasis on the side with severe disease, and with slight disease was 33.3%, 39.4%, 18.2%and 9.1%respectively. The overall incidence of metastasis on the side with severe disease and with slight disease metastasis was 48.5%and 57.6%, which was similar (χ2=0.547, P=0.459). Tumor size>1 cm and lateral neck metastasis were risk factors of central compartment lymph node metastasis, while capsular invasion and lateral neck metastasis were individual risk factors in the case of unilateral metastasis. Conclusion Bilateral PTC has frequent and occult metastasis of central com-partment, bilateral central compartment dissection is recommended when applicable.