预防性中央区淋巴结清扫在cN0乳头状甲状腺癌的临床价值

目的研究预防性中央区淋巴结清扫（CND）对临床无淋巴结转移（cN0）乳头状甲状腺癌的临床价值。方法回顾性分析中山大学附属第三医院1998年1月-2008年12月收治的232例cN0甲状腺乳头状癌患者的临床资料。结果将患者分为A组（CND组,n=112）与B组（无CND组,n=120）,两组患者在年龄、性别、原发肿瘤大小方面无明显差异,A组及B组中中央区淋巴结转移分别为49例（43.8%）和6例（5.0%）,术后接受131I治疗的患者较B组多（P=0.013）;两组均无死亡病例;A组和B组分别有5例（4.4%）和8例（96.6%）复发,组间无明显差异（P=0.776）,A组复发病例均为pN1患者。在A组患者中分析淋巴结转移的危险因素,原发肿瘤的分级与是否有包膜外侵犯与淋巴结转移相关。结论目前不能证实中央区淋巴结清扫可以改善cN0乳头状甲状腺癌患者的生存率或减少肿瘤复发,但中央区淋巴结清扫有助于对肿瘤准确分期,可用于指导术后综合治疗和随访管理。

Clinical Evaluation on Role of Prophylactic Central Neck Dissection in Patients with cN0 Papillary Thyroid Cancer

Objective To assess the clinical benefits of prophylactic central neck dissection（PCND） in patients with clinically negative neck（cN0） papillary thyroid cancer（PTC）.Methods The clinical data of 232 patients with a cN0 PTC from 1998 to 2008 were retrospectively evaluated.Results All 232 patients without obvious difference in age,sex and the size of primary tumor were divided into two groups.One hundred and twelve cases in group A underwent CND,while other 120 cases in group B underwent thyroidectomy alone.Forty-nine cases（43.8%） in group A,vs.6 cases in group B,had a high lymph node metastasis rate,and more patients underwent 131I treatment（P=0.013）.There was no death case in both groups.The overall recurrence rate was 4.46%（5/112） in group A and 6.67%（8/120） in group B（P=0.776）.All the patients with recurrence in group A had nodal involvement.The hazard factors analysis indicated that T3-4 and extracapsular invasions were the relevant factors.Conclusion The PCND,even though no evidence indicated its beneficial effect on overall survival and reduction of recurrence,has a certain potential predictive value for the recurrence of PTC,staging,post-operative comprehensive treatment and follow-up.