人甲状腺乳头状癌与正常腺体组织蛋白质组差异表达分析

目的 比较人甲状腺乳头状癌(papillary thyroid carcinoma,PTC)与正常腺体组织差异表达的蛋白质,筛选PTC特异的肿瘤标志物并初步探讨其发病机制.方法 利用固相pH梯度双向凝胶电泳技术,分离PTC以及正常腺体组织的总蛋白,建立PTC与正常腺体组织的蛋白表达谱;用Image Master 2D Elite5.0图像分析软件,比较两种组织间蛋白表达差异,利用基质辅助激光解吸电离飞行时间质谱对差异蛋白进行鉴定和Swiss-port数据库搜索.结果 建立了人PTC与正常腺体组织的蛋白表达谱,通过图像分析发现60个差异蛋白点,经质谱鉴定出17种PTC表达失调蛋白,其中G1/S特异性周期蛋白-D2、锰-超氧化物歧化酶、半乳糖凝集素3等11种蛋白在PTC中过表达,过氧化还原酶-2、热休克蛋白5、热休克蛋白27等6种蛋白在PTC中低表达.结论 PTC与正常腺体组织间存在多种差异表达的蛋白质,其可能通过影响细胞周期调控、细胞代谢及参与肿瘤的侵袭与转移等机制参与PTC的发生和发展.     

STAT3蛋白活化与甲状腺乳头状癌上皮间质转化的关系及意义

目的：探讨STAT3、p-STAT3蛋白在甲状腺乳头状癌（PTC）中的表达及其与上皮间质转化的关系及意义。方法：采用免疫组织化学方法检测56例PTC组织中STAT3、p-STAT3蛋白及上皮标志物E—cadherin和间质标志物Vimentin蛋白的表达,分析其与PTC临床病理特征间的关系及相互之间的相关性。结果：PTC组织中STAT3、p—STAT3蛋白的阳性表达率为78．6％和83．9％,明显高于癌旁甲状腺组织中的阳性表达率33．3％和20．8％（P〈0．01）。PTC组织中E-cadherin的阳性表达率为37．5％,明显低于癌旁甲状腺组织中的阳性表达率91．7％（P〈0．01）,PTC组织中Vimentin蛋白的阳性表达率为85．7％,明显高于癌旁甲状腺组织中的阳性表达率8．3％（P〈0．01）。STAT3、p-STAT3、E—cadherin、Vimentin蛋白的表达与性别、年龄无明显相关性（P〉0．05）,而均与PTC淋巴结转移、临床分期明显相关（P〈0．05）。STAT3、p-STAT3蛋白的表达和E—cadherin蛋白的表达呈负相关（r=-0．494,r=-0．364,均P〈0．01）,STAT3、p—STAT3蛋白的表达与Vimenin蛋白的表达呈正相关（r=0．533,P=0．000;r=0．377,均P〈0．01）。结论：PTC组织中存在STAT3蛋白活化及EMT,且与PTC淋巴结转移密切相关;STAT3通路激活可能通过介导PTC细胞EMT促进PTC侵袭转移。     

三叶因子3和SDF-1/CXCR4生物轴在甲状腺乳头状癌中的表达及临床意义

目的：研究三叶因子3、基质细胞衍生因子-1（SDF-1）及其受体CXCR4在甲状腺乳头状癌（PTC）,中的表达,探讨三者在乳头状癌发生、发展和转归中的作用及相关性。方法：应用免疫组织化学法（SP法）检测92例PTC及癌旁组织中TFF3、SDF-1及CXCR4的表达,采用图像分析软件系统对免疫组织化学结果进行半定量分析。结果：①TFF3蛋白表达于癌细胞胞质,癌旁滤泡上皮细胞TFF3阴性或弱阳性,TFF3阳性率92.39%,其中临床Ⅲ~Ⅳ期强阳性率为71.19%（42/59）,Ⅰ~Ⅱ期强阳性率为33.33%（11/33,P〈0.01）;有淋巴结转移者明显高于无淋巴结转移者（100.00%vs 86.27%,P〈0.05）。TFF3的AOD值在PTC内高于癌旁、有淋巴结转移者高于无淋巴结转移者、临床Ⅲ~Ⅳ期高于Ⅰ~Ⅱ期（P〈0.05或P〈0.01）。②SDF-1表达于胞质,转移淋巴结和癌旁细胞为弱阳性或阴性。SDF-1阳性率和AOD值在PTC内高于癌旁、有淋巴结转移者高于无淋巴结转移者、临床Ⅲ~Ⅳ期高于Ⅰ~Ⅱ期、45岁以上高于45岁以下者（P〈0.05或P〈0.01）;CXCR4主要表达于胞质,少数表达于胞核,癌旁组织中呈弱阳性或阴性,PTC中CXCR4表达的阳性率和AOD值与SDF-1相似：癌内高于癌旁、与临床分级、淋巴结转移和年龄有关（P〈0.05或P〈0.01）。③PTC中,TFF3与SDF-1蛋白、SDF-1与CXCR4蛋白表达水平呈正相关（r=0.971,P〈0.01）。结论：TFF3、SDF-1、CXCR4在PTC中的高表达与癌的发生、发展有关,对判断PTC的恶性程度和病情进展有重要价值。     

鼻咽癌组织中环氧合酶-2和基质金属蛋白酶-2的表达及与淋巴结转移的关系

目的:研究环氧合酶-2(COX-2)和基质金属蛋白酶-2(MMP-2)在鼻咽癌(NPC)组织中的表达及其与淋巴结转移的关系.方法:应用免疫组织化学SP法检测86例NPC组织中COX-2和MMP-2蛋白的表达,并与淋巴结转移的临床资料进行对比分析.结果:COX-2和MMP-2在NPC组织中的阳性率分别为75.58%和66.28%,显著高于正常鼻咽黏膜组织(均P<0.01);它们的表达与淋巴结转移呈正相关(均P<0.01),2种蛋白的表达之间呈正相关(P<0.01).结论:NPC组织中COX-2和MMP-2的表达均增高;二者在肿瘤淋巴结转移的过程中可能起协调作用.     

缺氧诱导因子1α、血管内皮生长因子及CXCR4受体在甲状腺乳头状癌中的表达及与肿瘤转移的关系

甲状腺乳头状癌(papillary thyroid carcinoma,PTC)占甲状腺恶性肿瘤的80%以上,大多数生长缓慢预后良好,但仍有一部分表现为明显的侵袭性行为,包括淋巴结转移、远处转移、治疗抵抗及致死性,寻找甄别及治疗该类PTC的方法是临床亟待解决的问题之一[1].缺氧诱导因子1α(hypoxia-inducible factor 1, alpha Subunit,HIF-1α)、血管内皮生长因子(vascular endothelial growth factor, VEGF)及CXCR4受体在体内外试验中均证实参与肿瘤的侵袭与转移过程,本研究拟检测发生淋巴结转移、肺转移及骨转移的PTC组织中的上述因子,研究其表达水平与肿瘤进展的关系.     

甲状腺乳头状癌中PTEN基因启动子甲基化及其蛋白表达的相关性

目的 探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)组织中PTEN基因启动子区域甲基化状态及其蛋白表达的相关性.方法 采用甲基化特异性聚合酶链反应及免疫组化SP技术,检测80例PTC及其相对应的癌旁组织中PTEN基因启动子甲基化状态及其蛋白表达.结果 在癌旁组织中,无一例出现PTEN基因启动子甲基化,而在PTC中,有25%(20/80)出现甲基化,且其甲基化状态与TNM分期、病理分级及淋巴转移有关(P值均<0.05);癌旁组织和PTC组织中,PTEN蛋白表达的阳性率分别为100.0%(80/80)和41.3%(33/80),P<0.01.在PTC组中,在病理分级Ⅰ级和Ⅱ级组,PTEN蛋白阳性率分别为54.0%(27/50)和20.0%(6/30),在淋巴转移阳性和阴性组分别为20.6%(7/34)和56.5%(26/46),以上两组比较差异有统计学意义(χ~2值分别为8.944和10.046,P值均<0.01);PTEN基因启动子甲基化与其蛋白表达有明显的相关性(χ~2=9.095,P<0.01).结论 PTEN基因启动子区域甲基化是该基因失活的重要机制之一,在PTC的发生、发展中起着重要的作用.     

喉鳞状细胞癌组织中VEGF和MVD的表达及与颈淋巴结转移的关系

目的 :探讨喉鳞状细胞癌 (LSCC)组织中血管内皮生长因子 (VEGF)mRNA及蛋白的表达和微血管密度 (MVD)与颈淋巴结转移的关系。方法 :用半定量逆转录 聚合酶链式反应 (semi RT PCR)技术和免疫组织化学方法检测 6 0例LSCC组织中VEGFmRNA及蛋白的定量表达及MVD。结果 :VEGF的表达无论在基因水平还是蛋白水平伴有颈淋巴结转移组都显著高于不伴有颈淋巴结转移组 (P <0 .0 1)。CD31免疫组织化学染色结果显示伴颈淋巴结转移组的MVD计数显著高于不伴颈淋巴结转移组 (P <0 .0 1)。LSCC组织中MVD计数升高与VEGF高表达呈正相关 (r =0 .94 8 4 ,P <0 .0 5 ) ,且二者与颈淋巴结转移相关。结论 :VEGF表达和瘤内MVD有良好的相关性 ,提示VEGF高表达对LSCC微血管生成起重要作用 ;VEGF高表达和瘤内高MVD与LSCC的颈淋巴结转移密切相关 ,二者有可能成为预测LSCC转移和预后的生物学指标 ;抗VEGF及其受体的抗血管生成治疗可能成为LSCC治疗的靶点     

PiWil2在甲状腺乳头状癌中的表达及其与侵袭转移的关系

目的 探讨piwil2在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中的表达及其与PTC的关系.方法 采用免疫组化、原位杂交检测60例PTC患者肿瘤组织及其癌旁组织中Piwil2蛋白和piwil2 mRNA的表达情况.结果 Piwil2蛋白在肿瘤组织和癌旁组织中的阳性表达率分别为8 8.3%(53/60)和10.0%(6/60),两者比较差异有统计学意义(x2=73.654,P＜0.01).piwil2 mRNA在肿瘤组织和癌旁组织中的阳性表达率分别为85.0%(51/60)和6.7%(4/60),两者比较差异有统计学意义(x2=74.148,P＜0.01).Piwil2蛋白及mRNA在PTC中的表达与患者的TNM分期及淋巴转移有关(P值均＜0.05).Piwil2蛋白及mRNA在PTC中的表达有相关性(x2=15.098,P＜0.01).结论 Piwil2参与了PTC的发生发展,与PTC的浸润和颈淋巴转移有关.

Abstract：

Objective To study the expressions of Piwil2 protein and mRNA in papillary thyroid carcinoma(PTC) and the relationship between Piwil2 and the invasion and metastasis of PTC. Methods Immunohistochemistry and in situ hybridization were used to detect the expression of Piwil2 protein and mRNA in 60 cases of PTC with the matched adjacent non-cancerous epithelium (NCE). Results The positive rates of Piwil2 protein expression in PTC and NCE were 88.3% (53/60) and 10.0% (6/60)respectively, with significant difference ( x2 = 73. 654,P ＜ 0.01 ). The positive rates of Piwil2 mRNA expression in PTC and NCE were 85.0% (51/60) and 6. 7% (4/60) respectively, also with significant difference (x2 =74. 148 ,P ＜0.01 ). Up-regulated expressions of Piwil2 protein and mRNA were related to the invasion and metastasis of PTC (P ＜ 0.05 ). Conclusion Piwil2 may play a role in the invasion and metastasis of PTC.     

P16抑癌基因与喉癌颈淋巴结转移和恶性度关系的探讨

目的:为了探讨P16蛋白表达与喉癌颈淋巴结转移及与癌组织恶性度的关系.方法:用免疫组化SP法对82例声门上型喉癌的原发灶、癌旁组织及颈淋巴结进行了P16蛋白表达的检测.结果:喉癌原发灶中P16蛋白表达阳性率54.9%;其中无颈淋巴结转移组阳性率为68.3%;有颈淋巴结转移组的阳性率41.5%,差异有显著性意义(P＜0.05).低度恶性组原发灶中P16蛋白表达阳性率62.2%;高度恶性组原发灶中P16蛋白表达阳性率41.7%,差异显著(P＜0.05).高度恶性及原发灶P16蛋白表达阴性组颈淋巴结转移率81.0%;低度恶性原发灶P16蛋白表达阳性组颈淋巴结转移率33.3%,转移率间也有显著性差异(P＜0.001),P16基因及其蛋白产物与喉癌的恶性度及颈淋巴结转移有相关倾向.结论:临床检测P16蛋白表达对判定喉癌组织的恶性度及推测颈淋巴结潜在性转移有一定参考价值.     

NF-κBp65、COX-2和VEGF在喉鳞状细胞癌中的表达及临床意义

目的 研究NF-κBp65、COX-2和VEGF在喉癌中的表达及相关性.方法 :应用流式细胞术(FCM)对原发喉癌新鲜癌组织及相应癌旁组织50例进行NF-κBp65、COX-2和VEGF表达的蛋白定量分析,以荧光指数(FI)表示3种蛋白表达的相对含量.结果 NF-κBp65、COX-2和VEGF在喉癌组织中的表达量分别为1.2、1.26和1.34,均明显高于癌旁组织.3种蛋白在有淋巴结转移组中的表达高于无淋巴结转移组.喉癌组织中NF-κBp65和COX-2的表达呈正相关(P<0.05).结论 NF-κBp65、COX-2和VEGF的高表达与喉癌的发生、发展及淋巴结转移密切相关,NF-κBp65可能促进COX-2的表达.     

甲状腺癌的临床病理及PET-CT的诊断价值

目的探讨甲状腺乳头状癌（papillary thyroid carcinoma,PTC）组织学变型的临床意义,明确PTC颈淋巴转移微生态系统（microecosystems）中各重要组成部分在肿瘤转移过程中的作用,并评价PET-CT在甲状腺癌分期、诊断中的价值.方法从天津医科大学附属肿瘤医院存档病例中选取有完整病历记录和追踪观察的PTC病例505例,按WHO最新甲状腺肿瘤的组织学分类标准重新分型,结合病例的临床特征,研究各组织学变型的生存率及颈淋巴转移情况.针对PTC淋巴转移高发的特性,利用组织芯片及免疫组化技术对PTC颈淋巴转移微生态系统中各重要组成部分进行多因素研究分析,其中包括细胞外基质（extracellular matrix,ECM）、蛋白水解酶、细胞黏附分子（cell adhesion molecular,CAM）、生长因子及细胞因子多方面指标.此外,研究中将PET-CT显像技术应用于1组甲状腺癌患者的对照总结.结果为便于临床应用,按照颈淋巴转移发生率的高低差异可将所有变型分为高转移变型组（高细胞型、弥漫滤泡型、柱状细胞型、弥漫硬化型）、中转移变型组（滤泡型、嗜酸性细胞型、实体状变型、筋膜炎样型、透明细胞型、典型PTC）和低转移变型组（大滤泡型、乳头状微癌）,3组的颈淋巴转移率分别为83.0%,55.5%及34.1%,3组差异有统计学意义（P＜0.05）.随访资料完整的248例统计,3组10年生存率分别为75.3%、95.8%、100.0%,3组差异有统计学意义（P＜0.05）;20年生存率分别为31.2%、80.3%、87.5%,3组差异有统计学意义（P＜0.05）.免疫组化研究显示ECM、蛋白水解酶、CAM、生长因子及细胞因子各指标在转移灶中阳性率为51.6%（整合素-β1）～98.3%（组织蛋白酶D）.在原发灶中阳性率为46.7%（纤维粘连蛋白）～98.3%（细胞间黏附分子）,其中E-钙黏蛋白（83.3%）明显低于正常组织细胞（P＜0.05）;其余指标皆明显高于正常组织细胞（P＜0.05）.PET-CT结果显示,其对原发灶检查灵敏度100%,特异性85.7%.结论不同组织学变型的PTC侵袭转移能力及预后存在较大差异,危险分层并细化外科处理原则.基础研究显示ECM、蛋白水解酶、CAM、生长因子及细胞因子共同参与了PTC肿瘤细胞的转移,部分指标可作为今后PTC研究的重点.此外,PET-CT对原发、转移及复发甲状腺癌均有较高的诊断价值,对临床一次性完善分期并明确治疗具有积极意义.     

Individualized optimal surgical extent of the lateral neck in papillary thyroid cancer with lateral cervical metastasis

Despite an excellent prognosis, cervical lymph node (LN) metastases are common in patients with papillary thyroid cancer (PTC). The presence of metastasis is associated with an increased risk of locoregional recurrence, which significantly impairs quality of life and may decrease survival. Therefore, it has been an important determinant of the extent of lateral LN dissection in the initial treatment of PTC patients with lateral cervical metastasis. However, the optimal extent of therapeutic lateral neck dissection (ND) remains controversial. Optimizing the surgical extent of LN dissection is fundamental for balancing the surgical morbidity and oncological benefits of ND in PTC patients with lateral neck metastasis. We reviewed the currently available literature regarding the optimal extent of lateral LN dissection in PTC patients with lateral neck metastasis. Even in cases with suspicion of metastatic LN at the single lateral level or isolated metastatic lateral LN, the application of ND including all sublevels from IIa and IIb to Va and Vb may be overtreatment, due to the surgical morbidity. When there is no suspicion of LN metastasis at levels II and V, or when multilevel aggressive neck metastasis is not found, sublevel IIb and Va dissection may not be necessary in PTC patients with lateral neck metastasis. Thus consideration of the individualized optimal surgical extent of lateral ND is important when treating PTC patients with lateral cervical metastasis.     

甲状腺乳头状癌Ⅱ区淋巴结隐匿性转移的临床分析

目的 分析甲状腺乳头状癌Ⅱ区淋巴结隐匿性转移的相关因素。方法 回顾分析天津医科大学附属肿瘤医院头颈外科2003年1月至2009年12月收治的213例术前Ⅱ区淋巴结临床阴性,颈侧其他区阳性的初治甲状腺乳头状癌患者的临床资料。淋巴清扫标本经病理证实颈侧区（Ⅱ～Ⅴ）有淋巴转移。单因素和多因素分析分别采用卡方检验和二分类Logistic回归分析。结果 颈部Ⅵ区淋巴结转移率79.3％( 169/213),Ⅲ、Ⅳ、Ⅴ区淋巴结转移率分别为83.6％( 178/213)、75.1％ (160/213)、13.1％ (28/213),Ⅱ区隐匿性淋巴结转移率为16.0％(34/213)。单因素分析显示：术前颈侧区Ⅲ、Ⅳ区淋巴结同时阳性或者术前Ⅲ区淋巴结阳性,与Ⅱ区淋巴结隐匿性转移密切相关（x2值分别为11.120和5.614,P值均＜0.05）;多因素分析显示术前颈侧区Ⅲ、Ⅳ区淋巴结同时阳性是隐匿性Ⅱ区淋巴转移的独立危险因素(P=0.033,OR =3.846)。结论 甲状腺乳头状癌患者术前未发现Ⅱ区和Ⅲ区淋巴结阳性时,可以考虑暂时不进行预防性Ⅱ区颈淋巴清扫术。     

Induction of cytotoxic activity from regional lymph node lymphocytes in head and neck malignant tumor]

Cytotoxic activities of rIL-2-stimulated effector cells from peripheral blood mononuclear cells (PBMC-LAK), and those from the regional lymph node cells (LN-LAK) from patients with head and neck malignant tumor were examined by 4-hour 51Cr release assay. Cytotoxicity of LAK cells from involved lymph node (LN (+)-LAK) were significantly lower than those of PBMC-LAK. LAK cells from non-involved lymph node (LN (-)-LAK) had a significantly higher cytotoxicity against Daudi cell than PBMC-LAK. Cytotoxic activities against K562 cell and autologous tumor cells mediated by LN (-)-LAK were not significantly different from those by PBMC-LAK. However, autologous tumor cell lysis by LN (-)-LAK from lymph nodes showing follicular lymphoid hyperplasia (FLH) pattern was higher than that by PBMC-LAK. The effector cells against autologous tumor cells were characterized CD56+ cells and CD8+ cells (CD8+CD11b- cells) by phenotypic analysis and negative selection assay using immunomagnetic isolation technique.     

Reliable sonographic features for nodal thyroglobulin to diagnose recurrent lymph node metastasis from papillary thyroid carcinoma

Objectives

Ultrasound‐guided aspiration cytology (US‐FNAC) was previously used to diagnose lymph node metastasis of papillary thyroid carcinoma (PTC). Combined US‐FNAC with nodal thyroglobulin (LN‐FNA‐Tg) significantly improved the diagnostic rate. However, diagnostic accuracy depends on proper node selection. Therefore, it is crucial to choose the nodes with reliable sonographic features to guide clinician for confirmation.

Design and Setting

Retrospective cohort study was carried out in one medical centre from 2011 to 2014.

Participants

A total of 148 patients with PTC, being treated by total thyroidectomy and radioiodine, were assessed for potential nodal metastases by ultrasound.

Main outcome measures

Lymph nodes with cystic content, peripheral hypervascularity, calcification, hyperechoic content, the absence of hilum and Solbiati index < 2 indicated risk of malignancy. US‐FNAC and LN‐FNA‐Tg were both performed. Positive nodal metastasis was further confirmed by dissection. Risk impact of these sonographic features on LN‐FNA‐Tg to diagnose nodal metastasis was tested by logistic regression analysis based on the significance in both univariate and multivariate models.

Results

Overall, 49 lymph nodes were documented as recurrent nodal metastasis. LN‐FNA‐Tg greater than serum thyroglobulin and higher than 1 ng/mL achieved 100% of diagnostic rate for recurrent nodal metastasis. The malignant sonographic features that significantly cohered with positive LN‐FNA‐Tg were cystic and hyperechoic content and lack hilum, in sequence.

Conclusions

LN‐FNA‐Tg is an excellent tool to quantitatively diagnose nodal metastasis. To achieve ideal diagnosis, the most reliable sonographic features were cystic content, hyperechoic content and the absence of hilum in lymph nodes, but not calcification or Solbiati index < 2.     

促甲状腺素抗氧化传导通路与甲状腺乳头状癌侵袭力的关系

目的 探讨促甲状腺素受体(thyroid-stimulating hormone recepter,TSHR)、抗氧化酶1(pemxiredoxin 1,Prxl)、硫氧还蛋白1(thioredoxin1,Trx1)、缺氧诱导因子1(hypoxia inducible factor-1,HIF-1)α在甲状腺乳头状癌侵袭、转移中的作用.方法 选取2003至2007年于天津市肿瘤医院手术切除的34例典型甲状腺乳头状癌石蜡包埋标本、39例高细胞型甲状腺乳头状癌石蜡包埋标本,以癌旁正常甲状腺组织作对照,采用免疫组织化学SP法,检测TSHR、Prx1、Trx1、HIF-1α在甲状腺乳头状癌中的表达,并将检测结果结合患者的临床资料(性别、年龄、肿瘤大小、局部侵犯、颈淋巴转移、组织学亚型、T分期)等进行分析.结果 甲状腺乳头状癌中的Prx1、Trx1、HIF-1α的阳性表达率均高于癌旁正常甲状腺组织(χ2值分别为5.49、6.16、40.48,P值均<0.05).甲状腺乳头状癌中的TSHR的阳性表达率低于癌旁正常甲状腺组织(χ2=15.70,P<0.05),高细胞型甲状腺乳头状癌的TSHR的阳性表达率低于典型甲状腺乳头状癌(χ2=4.24,P<0.05).肿瘤侵犯甲状腺被膜外、有颈淋巴转移、高细胞型、T3-T4期甲状腺乳头状癌的Prx1、Try1、HIF-1α的阳性表达率更高,差异有统计学意义(P值均<0.05).甲状腺乳头状癌中Trx1与Prx1、Trx1与HIF-1α的阳性表达具有关联性(列联系数分别为0.664和0.652,P值均<0.05).结论 甲状腺乳头状癌中Prx1、Trx1和HIF-1α的高表达与肿瘤的侵袭和转移有关,TSH可能通过Prx1-Trx1-HIF-1信号传导通路促进甲状腺癌的发展.     

Ⅵ区淋巴结在甲状腺乳头状癌颈淋巴转移中的意义

目的 进一步认识Ⅵ区淋巴结在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)颈转移中的地位及PTC患者颈部转移淋巴结的分布特点,为PTC的颈部淋巴结处理提供依据.方法 回顾性总结2002年1月至2004年12月97例病变局限于一侧腺叶的PTC患者的临床资料:72例术前检查为cNO,25例为cN+;32例原发灶长径≤1 cm,65例原发灶长径＞1 cm.术中常规取Ⅲ、Ⅳ区淋巴结做冰冻病理检查,根据淋巴结病理结果、肿瘤原发灶大小及位置决定颈部淋巴结的清扫范围.Ⅲ、Ⅳ区淋巴转移患者行包括Ⅵ区的改良性颈清扫;伴有肿瘤包膜外侵患者行双侧Ⅵ区清扫;原发灶长径≤1 cm行患侧Ⅵ区清扫;原发灶长径＞1 cm行双侧Ⅵ区清扫.结果 97例患者行Ⅵ区清扫122侧,45.1%(55/122)发生淋巴转移.72例cN0患者45.8%(33/72)发生Ⅵ区淋巴转移,25例cN+患者76.0%(19/25)发生Ⅵ区淋巴转移,差异有统计学意义(x2=6.790,P=0.009).10例原发灶包膜外侵患者的淋巴转移发生率为65.0%(13/20),87例无包膜外侵患者的淋巴转移发生率为41.2%(42/102),差异有统计学意义(x2=3.833,P=0.047).32例原发灶长径≤1 cm的患者行患侧Ⅵ区清扫,43.8%(14/32)发生淋巴转移,65例原发灶长径＞1 cm患者行双侧Ⅵ区清扫,69.2%(45/65)有患侧Ⅵ区转移,23.1%(15/65)有双侧Ⅵ区转移,两组间同侧Ⅵ区转移率的差异有统计学意义(x2=5.843,P=0.016).结论 Ⅵ区为FTC较早发生淋巴转移的区域,伴有原发灶包膜外侵犯者易发生Ⅵ区淋巴转移.原发灶长径≤1 cm的患者可发生同侧Ⅵ区转移;原发灶长径＞1 cm者可发生双侧Ⅵ区转移.PTC颈淋巴转移可单独或同时发生在Ⅵ区或侧颈区的任何一个区域.术中应常规做Ⅲ、Ⅳ区淋巴结冰冻病理检查,淋巴结阳性者行包括Ⅵ区的改良性颈清扫.     

Incidence and clinical characteristics of prelaryngeal lymph node metastasis in papillary thyroid cancer

There is little data that determine the clinical characteristics of prelaryngeal lymph nodes (PLN) metastasis in patients with papillary thyroid cancer (PTC). The aims of this prospective study were to evaluate the incidence and the clinical characteristics of metastasis to the PLN for PTC patients who underwent total thyroidectomy and prophylactic central neck dissection. Sixty-seven patients who underwent total thyroidectomy and prophylactic bilateral central lymph node neck dissection for PTC were enrolled. Central neck compartment was further divided into prelaryngeal, ipsilateral/contralateral paratracheal, and pretracheal regions. Clinicopathologic factors including age, sex, tumor size and location, extrathyroidal extension, and central and lateral nodal metastasis were evaluated. Of the 67 patients who underwent PLN dissection, 13 (19.4 %) had evidence of PLN metastasis. Tumor size was significantly larger in patients with PLN involvement (2.28 versus 1.12 cm; p = 0.020). Additionally, primary tumors larger than 1 cm, extrathyroidal extension, and isthmus involvement were more prevalent in PLN-positive patients. Patients with positive PLNs were also more frequently found to have lateral lymph node metastasis (23.1 vs. 1.9 %; p = 0.021), pretracheal lymph node metastasis (76.9 vs. 27.8 %; p = 0.003), and bilateral central lymph node metastasis (38.5 vs. 11.1 %; p = 0.031) than PTC patients without PLN involvement. The incidence of PLN metastasis in PTC patients who underwent prophylactic central lymph node neck dissection was 19.4 %. PLN metastasis was associated with tumor size, extrathyroidal extension, isthmus involvement, and other compartment lymph node metastasis.