甲状腺乳头状癌颈淋巴结转移部位及机率的研究

甲状腺乳头状癌颈淋巴结转移率甚高，行颈淋巴结清除术时，在彻底清除颈淋巴结转移癌的同时，尚需注意保护颈部的外形及功能。探讨癌瘤在颈部各组淋巴结的转移率及每组淋巴结的阳性率，对颈清术的范围及术式的改进有一定的临床意义。我院对1983～1987年收治的甲状腺乳头状癌行颈清术156例（患者151例，5例双侧）术后颈大块标本，逐个进行切片检查，对各组淋巴结的转移率及每组淋巴结的阳性率统计分析如下。1临床资料1.1一般资料151例中，男67例，女84例；年龄13～69岁，其中13～40岁89例。治疗性颈清术57例，选择性颈清术99例（均按标本计，…     

甲状腺乳头状癌颈淋巴结转移规律与手术方式的选择

目的:从甲状腺乳头状癌颈部淋巴结转移规律探讨其最佳手术方式.方法:回顾性分析我院近三年367例甲状腺乳头状癌(papillary thyriod carcinoma,PTC)根治术患者的临床及病理资料.结果:颈淋巴结总转移率为77.11%(283/367),中央区(VI区)转移率为 70.30%(258/367),颈侧区(Ⅱ、Ⅲ、Ⅳ、Ⅴ区)转移率为 62.67%(230/367),颈侧区中的Ⅱ区转移率最高60.49%(222/367).发病年龄、原发灶个数、肿瘤是否累及被膜、癌灶直径、肿瘤边界是否清晰、癌灶位置、超声血流信号分级、癌症是否合并桥本氏甲状腺炎或结节性甲状腺肿对颈部淋巴结转移的影响差异均有统计学意义(P<0.05);性别因素及癌灶是否钙化对颈部淋巴结转移的影响差异无统计学意义(P>0.10),经logistic回归分析发现,肿瘤是否累及被膜对颈部淋巴结转移的影响因素最大.结论:VI区是甲状腺乳头状癌最常见的转移部位,术中应常规清除,其次依次为Ⅱ、Ⅲ、Ⅳ、Ⅴ区.对于患者原发肿瘤若累及包膜、或多发病灶、或癌灶直径>1 cm及患者发病年龄<45岁等应同时做颈侧区清扫.     

甲状腺乳头状癌颈淋巴结转移的病理研究及临床意义

甲状腺乳头状癌颈淋巴结转移是影响患者预后的重要因素 ,目前对颈淋巴结转移的术前诊断仍无可靠方法。我们收稿日期 :2 0 0 0 -0 2 -2 8作者单位 :浙江绍兴第二医院 ,浙江　绍兴　312 0 0 0通过对 42例甲状腺乳头状癌及其单侧颈淋巴结清除术标本的连续切片 ,着重观察颈淋巴结转移的病理特点 ,并分析颈淋巴结转移和原发病变的关系。1　材料与方法收集我科 1995年— 1999年 5 a中42例甲状腺乳头状癌及其单侧颈淋巴结清除术标本 ,按 U ICC标准 (1987)分期 : 期 9例、 期 15例、 期 13例、 期 5例。标本采用石蜡包埋 ,连续切片 ,厚度为 4μm,H…     

甲状腺乳头状癌颈淋巴结转移与临床病理因素相关性分析

目的 探讨甲状腺乳头状癌的临床病理特点与颈淋巴结转移的关系。方法 对１２５例甲状腺乳头状癌患者的临床病理特点及结果进行回顾性分析总结。结果 不同组织学亚型的淋巴结转移率之间差异有显著性（Ｐ〈０．０５）;肿瘤与包膜浸润与否和淋巴结转移有关（Ｐ〈０．０２５）;肿瘤的大小与颈淋巴的转移呈正相关性,差异有显著性（Ｐ〈０．０５）;男性淋巴结转移远高于女性,两者差异有显著性（Ｐ〈０．０５）,病史〉２年与〈２年     

甲状腺乳头状癌颈淋巴结转移途径

[目的]探讨甲状腺乳头状癌颈淋巴结可能的转移途径，及气管旁淋巴结与颈外侧淋巴结转移的相关性。[方法]回顾分析54例资料完整的甲状腺乳头状癌的临床及病理资料，分析颈部各区淋巴结转移率，比较气管旁淋巴结转移与颈外侧区淋巴结转移的关系。[结果]颈深上(Ⅱ区)、颈深中(Ⅲ区)、颈深下(Ⅳ区）、副神经区(V区）、气管旁(Ⅵ区)淋巴结转移率分别为25．9％、50．O％、59．3％、14．8％、70.4％，气管旁淋巴结转移者84．2％有颈外侧区淋巴结转移。气管旁淋巴结无转移者仅18．8％有颈外侧区淋巴结转移。[结论]气管旁是甲状腺乳头状癌颈淋巴结最常见转移部位，气管旁淋巴结转移与颈外侧区淋巴结转移有相关性。     

伴颈部淋巴结转移的甲状腺乳头状癌的基因差异表达

背景与目的：甲状腺乳头状癌是预后较好的一种恶性肿瘤，颈部淋巴结转移是其主要的转移方式。近年来迅猛发展起来的基因芯片技术是研究肿瘤生物学行为的一种快速、高效的方法。本研究拟比较初治有颈部淋巴结转移（cN1）的甲状腺乳头状癌组织与正常甲状腺组织的基因差异表达，筛选甲状腺乳头状癌的转移相关基因。方法：分别用Cy3和Cy5两种荧光染料标记两组组织的总mRNA，与含有14112个基因位点的芯片进行杂交。通过对荧光信号的扫描、分析，筛选两组差异表达的基因。结果：共有1212个基因位点在两组间出现差异表达，占总基因点位数的8．71％。其中22个位点呈显著差异表达（上调或下调8倍以上）。在显著下调的6个位点中，有2个位点代表同一个基因序列（NM-001920）——decorin蛋白的mRNA序列。结论：基因芯片是研究疾病发生发展过程中基因表达改变的有效方法之一。PTC的发生发展（包括颈部淋巴结转移）涉及众多的基因参与。Decorin蛋白可能在甲状腺乳头状癌颈部淋巴结转移中发挥重要作用。     

miRNA-451表达与甲状腺乳头状癌患者淋巴结转移、外侵的关系

目的:检测miRNA-451在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中的表达及与有无淋巴结转移、外侵的关系。方法:收集150例PTC患者的临床资料及石蜡组织,用miRNA芯片技术分析比较miR-451在有无淋巴结转移间,转移淋巴结数≥3个与<3个间,癌组织有无外侵间的表达差异。结果:相对于无淋巴结转移,伴有淋巴结转移的PTC中miR-451的表达显著降低（P＜0.05）。在颈部转移淋巴结≥3个PTC中较<3个表达下调更显著（P＜0.05）。相对于无外侵,miR-451在有外侵的PTC中的表达显著降低（P＜0.05）。结论:miRNA-451在PTC中表达显著下调,在伴有淋巴结转移的PTC中下降更加显著,可能有助于诊断PTC及淋巴结转移情况。     

甲状腺乳头状癌病理组织学亚型与颈淋巴结转移相关性探讨

目的: 分析探讨甲状腺乳头状癌的组织学亚型与颈淋巴结转移的相关因素。 方法: 对602例甲状腺乳头状癌患者各种病理组织学亚型发生颈淋巴结转移多种因素的相关性进行回顾性分析总结。 结果: 602例甲状腺乳头状癌共分成8个组织学亚型,颈淋巴结总转移率为65.0%(391/602),一般乳头(普通乳头)型、弥漫硬化型、包膜外型(包裹型侵出包膜)及滤泡亚型颈淋巴结转移率分别为72.4%(131/181)、75.2%(79/105)、80.3%(57/71)、73.0%(46/63),明显高于水肿乳头型(40.6%)(26/46)、高细胞型(46.2%)、微小型(47.8%)及包膜内型(30.0%)(P<0.01);颈部各区淋巴结转移率依次为Ⅲ区(49.5%)、Ⅳ区(42.3%)、Ⅱ区(38.5%)、Ⅵ区(30.2%)、Ⅴ区(8.9%)及Ⅰ区(1.6%)。 结论: 甲状腺乳头状癌颈淋巴结转移率与不同亚型密切相关。     

甲状腺乳头状癌淋巴结转移率和远处转移的关系

背景与目的：颈部淋巴结转移在甲状腺乳头状癌(papillary thyroid carcinoma,PTC)中多见。该研究旨在探讨PTC淋巴结转移率(the rate of involved lymph nodes,LR)与远处转移(distant metastasis,DM)的关系,及其对DM的预测价值。方法：随访162例PTC患者,将其分为DM组(M1组)41例和非DM组(M0组)121例,采用t检验、χ2检验分别比较两组患者的基本病理特征。采用多因素分析评估LR在预测DM的意义。利用受试者工作特征(receiver operating characteristic curve,ROC)曲线及最佳诊断界值点评估LR及淋巴结转移数目(the number of involved lymph nodes,LNs)对DM的预测价值,进一步采用Kaplan-Meier曲线评估LR及LNs发生DM的累积风险,使用Log-rank法对差异进行统计学分析。结果：两组患者在年龄及多灶性方面差异无统计学意义(P>0.05),在男性(χ2=13.039,P=0.000)、腺外侵犯(χ2=2.941,P=0.000)、病灶大小(t=－4.485,P=0.000)方面存在显著差异。LR可以作为预测DM的独立因素(OR=1.133,P=0.000)。随着LR的增高,LNs大于等于15组患者的DM风险显著高于LNs小于15组(P=0.0002)。结论：LR可作为DM的独立预测指标,其与LNs结合可以更好地预测DM的发生风险。     

甲状腺乳头状癌uPA表达和微血管密度与颈部淋巴结转移的关系

目的探讨血管新生和(或)尿激酶型纤溶酶原激活物(urokinase-typeplasmino-genactivator,uPA)的表达与甲状腺乳头状癌(papillarythyroidcarcinoma,PTC)颈部淋巴结转移的关系。方法应用免疫组织化学SP法检测PTC中uPA的表达和以CD105抗体标志的微血管密度(microvesseldensity,MVD)。结果有颈部淋巴结转移和无淋巴结转移的PTC的uPA阳性表达率分别为72.89%(43/59)和38.71%(12/31),两组间差异有统计学意义,χ2=9.96,P=0.002。59例有颈部淋巴结转移PTC的MVD值(76.18±4.98)显著高于31例无淋巴结转移者的MVD值(38.01±3.92),t=37.03,P=0.000。uPA阳性表达且具有高MVD的PTC的淋巴结转移率为92.50%,明显高于uPA阳性表达但具有低MVD组(46.67%)、uPA阴性表达但具有高MVD组(50.00%)和uPA阴性表达且具有低MVD组(40.74%),χ2=23.45,P=0.000。结论活跃的血管生成和uPA的过表达与PTC颈部淋巴结转移的发生密切相关,PTC中uPA过表达且具高MVD者越容易发生颈部淋巴结转移,这对临床筛选高危淋巴结转移病例具有重要的指导意义。     

Postoperative recurrence of papillary thyroid carcinoma with lymph node metastasis

Background and Objectives

: The purpose of this study was to retrospectively analyze the features of patients with papillary thyroid carcinoma (PTC) presenting with neck lymph node (LN) metastasis.

Methods

: The study enrolled 909 patients with PTC who had undergone total thyroidectomy. After a median follow‐up of 14.6 years, 73 (8.0%) patients died of thyroid cancer. A total of 536 patients had the tumor confined to the thyroid (intra‐thyroid), 111 had lymph node (LN) metastasis, 225 showed soft tissue invasion, and 37 had distant metastasis.

Results

: Compared with the intra‐thyroid group, the group with LN metastases showed larger tumor size, higher postoperative thyroglobulin levels, advanced TNM stage, higher recurrence rates (5.2% vs. 31.5%), and higher disease‐specific mortality (1.3% vs. 12.6%). Of the 111 patients with PTC and LN metastases, 35 (31.5%) were diagnosed with recurrence during a mean follow‐up period of 16.9 ± 0.6 years. Among the 35 patients with recurrent PTC, 14 (40.0%) died of thyroid cancer. The mortality group was characterized by older, mostly male patients who presented with larger initial tumor size compared with survivors.

Conclusions

: In patients with PTC, the rates of recurrence and cancer mortality were higher in the group with LN metastasis than that in the intra‐thyroid tumor group. J. Surg. Oncol. 2015 111:149–154. © 2015 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.     

Predictive value of the Delphian lymph node in cervical lymph node metastasis of papillary thyroid carcinoma

IntroductionDelphian lymph node metastasis (DLNM) has proven to be a risk factor for a poor prognosis in head and neck malignancies. This study aimed to reveal the clinical features and evaluate the predictive value of the Delphian lymph node (DLN) in papillary thyroid carcinoma (PTC) to guide the extent of surgery.MethodsTianjin Medical University Cancer Institute and Hospital pathology database was reviewed from 2017 to 2020, and 516 PTC patients with DLN detection were enrolled. Retrospective analysis was performed, while multivariate analysis was performed to identify the risk factors for DLNM.ResultsAmong the 516 PTC patients with DLN detection, the DLN metastasis rate was 25.39% (131/516). Tumor size >1 cm, location in the upper 1/3, central lymph node metastasis (CLNM), lateral lymph node metastasis (LLNM) and lymphovascular invasion were independent risk factors for DLNM. Patients with DLNM had a higher incidence of ipsilateral CLNM, contralateral CLNM (CCLNM) and LLNM, and larger numbers and size of metastatic CLNs than those without DLNM. The incidence of CLNM among cN0 patients with DLNM was higher than that among those without DLNM. The incidence of CCLNM among unilateral cN + patients with DLNM was similarly higher than that among patients without DLNM.ConclusionsDLNM indicates a high likelihood and large number of cervical lymph nodes metastases in PTC patients. Surgeons are strongly recommended to detect DLN status during operation by means of frozen pathology, so as to evaluate the possibility of cervical nodal metastasis and decide the appropriate extent of surgery.     

甲状腺乳头状癌颈侧区淋巴结转移的影响因素

甲状腺乳头状癌是甲状腺癌中最常见的病理类型,具有恶性程度低、进展缓慢、病程长、预后好等生物学特点,但易发生颈侧区淋巴结转移.甲状腺乳头状癌颈侧区淋巴结转移与年龄、性别、肿瘤大小、肿瘤部位、被膜受累/腺外侵犯、多灶性、中央区转移淋巴结数量等因素相关.了解甲状腺乳头状癌颈侧区淋巴结转移的影响因素对甲状腺乳头状癌颈淋巴结清扫范围的确定及其适应证具有重要的临床意义.     

甲状腺乳头状癌颈部淋巴结转移特点及清扫策略

背景与目的：目前,在甲状腺癌颈淋巴结清扫方面存有较大分歧。该研究总结甲状腺乳头状癌淋巴结转移的特点,为择区淋巴结清扫提供理论依据。方法：回顾性分析2006年7月—2014年8月收治的462例甲状腺乳头状癌患者病历资料,分析其淋巴结转移规律及其影响因素,评判cN0标准的准确性。结果：全组患者均行患侧中央区(Ⅵ区)淋巴结清扫,320例行侧颈区淋巴结清扫术(Ⅱ～Ⅴ区)或择区淋巴结清扫(Ⅱ～Ⅳ区中的部分或全部),90例行对侧中央区淋巴结活检。73.2%(338/462)符合cN0标准,病理证实其中有184例淋巴结转移,cN0标准误诊率达60.9%。颈部淋巴结总转移率为65.4%(302/462),侧颈区淋巴结转移率为42.6%(197/462),“跳跃转移”率为13.1%(42/320),对侧中央区淋巴结转移率为50%(45/90)。男性、肿瘤累及腺叶上1/3、肿瘤T3或T4、多中心病灶是淋巴结转移的危险因素。肿瘤累及腺叶上1/3是喉前淋巴结转移及“跳跃转移”的危险因素。喉前淋巴结转移及中央区淋巴结2个以上转移者侧颈区淋巴结转移率显著增加(分别为85.7%和83.3%, P＜0.05)。结论：现行cN0标准不能作为确定淋巴结清扫范围的依据;甲状腺乳头状癌易发生淋巴结转移,其中Ⅵ区淋巴结转移率最高,依次为Ⅲ区、Ⅱ区、Ⅳ区、Ⅴ区;初次手术应常规清扫患侧中央区淋巴结,建议将Ⅵ区淋巴结送冰冻病理;当喉前淋巴结有转移或Ⅵ区2个以上淋巴结转移时,或肿瘤累及腺叶上1/3者,有必要行侧颈区(或择区)淋巴结清扫;对侧中央区淋巴结转移率较高,需予以重视;中央区淋巴结再分亚区具有重要意义,应深入研究。     

VEGF-D和VEGFR-3表达与食管鳞癌淋巴结转移相关性的探讨

目的:探讨VEGF-D/VEGFR-3信号通路与食管鳞癌淋巴结转移的关系。方法:采用逆转录多聚酶链反应技术(RT-PCR)检测VEGF-D及其受体VEGFR-3在52例食管鳞癌组织和20例正常食管组织中的表达,并分析其与食管鳞癌临床病理指标的关系。结果:在正常食管组织中VEGF-D和VEGFR-3mRNA表达均呈阴性;在食管鳞癌组织中,VEGF-DmRNA阳性表达32例(61.5%),VEGFR-3mRNA阳性表达28例(53.8%)。VEGF-DmRNA和VEGFR-3mRNA表达与食管鳞癌淋巴结转移显著相关,χ2值分别为15.333和15.594,P均<0.01;与浸润深度亦显著相关,χ2值分别为25.646和10.511,P均<0.05;VEGF-D与VEGFR-3表达呈正相关,χ2=25.142,P=0.001。结论:VEGF-D及VEGFR-3信号通路与食管鳞癌淋巴结转移及进展程度关系密切。     

CXCR4 expression in papillary thyroid carcinoma: induction by nitric oxide and correlation with lymph node metastasis

Background  

Metastasis to regional lymph nodes is a common step in the progression of cancer. Recent evidence suggests that tumor production of CXCR4 promotes lymph node metastasis. Nitric oxide (NO) may also increase metastatic ability in human cancers.     

Relationship between VEGF protein expression and lymph node metastasis in papillary thyroid carcinoma among Asians: a meta-analysis

We carried out the current meta-analysis of relevant cohort studies in an attempt to investigate the relationships between vascular endothelial growth factor (VEGF) protein expression and lymph node (LN) metastasis in papillary thyroid carcinoma (PTC) among Asians. A range of electronic databases were searched, including Web of Science (1945?～?2013), the Cochrane Library Database (Issue 12, 2013), MEDLINE (1966?～?2013), EMBASE (1980?～?2013), CINAHL (1982?～?2013), and Chinese Biomedical Database (CBM) (1982?～?2013) with cross-referencing without language restrictions. Meta-analysis was conducted using the STATA 12.0 software. Crude odds ratio (OR) with their 95 % confidence interval (95 %CI) was calculated. Twelve clinical cohort studies with a total of 1,045 PTC patients were included in our meta-analysis, The results of our meta-analysis revealed that patients with VEGF-positive tumors had a 3.02-fold higher risk of LN metastasis than that of patients with VEGF-negative tumors (OR?=?3.02, 95 %CI?=?2.05?～?4.43, P?<?0.001). Furthermore, subgroup analysis by country suggested that VEGF-positive expression was associated with an increased risk of LN metastasis in PTC patients among Chinese populations (OR?=?3.33, 95 %CI?=?2.30?～?4.83, P?<?0.001), but not among Korean, Turkish, and Japanese populations (all P?>?0.05). Our findings support the view that VEGF protein expression may be correlated with LN metastasis in PTC patients, especially among Chinese populations.     

甲状腺乳头状癌组织E-cadherin蛋白表达及其与颈部淋巴结转移相关性研究

目的:探讨E-cadherin蛋白在甲状腺乳头状癌组织中表达及其与颈部淋巴结转移的关系.方法:应用免疫组织化学En Vision法检测165例甲状腺乳头状癌组织及癌旁正常甲状腺组织中E-cadherin蛋白的表达.结果:甲状腺乳头状癌组织中E-cadherin阳性表达率为40.6%(67/165),明显低于癌旁正常甲状腺组织的90.9%(150/165),P<0.01.E-cadherin在甲状腺乳头状癌组织中的表达与分化程度、是否有颈部淋巴结转移、浸润深度以及AJCC分期密切相关,P值均<0.01.Logistic回归分析显示,E-cadherin表达与PTTC颈部淋巴结转移有强相关性,OR=14.935,P<0.01.结论:E-cadherin蛋白在甲状腺乳头状癌组织中表达下调,是影响甲状腺乳头状癌颈部淋巴结转移的相关因子.     

Impact of Lin28 on lymph node metastasis in papillary thyroid carcinoma

Lin28 is involved in the progression of several types of tumors. Data collected from clinical trials have suggested that Lin28 expression is correlated with poor prognosis in thyroid carcinoma. The present study was conducted to investigate the association between Lin28 expression and the clinicopathological parameters of papillary thyroid carcinoma (PTC). Accordingly, the clinical data and diagnostic results from 237 patients with PTC were collected. Immunohistochemical staining was performed to evaluate the Lin28 expression levels in thyroid tissue samples. Associations between the expression levels and clinicopathological parameters were evaluated. Lin28 was expressed in 96/237 (40.5%) of PTC specimens. Compared with patients with no Lin28 expression, patients with expression had higher rates of lymph node metastasis (P<0.001) and larger tumors (P=0.011). Multivariate analysis revealed that Lin28 was associated with lymph node metastasis. Next, bioinformatics analysis was performed based using the Gene Expression Omnibus database and The Cancer Genome Atlas database. Lin28 expression was associated with aggressive tumor characteristics, such as lymph node metastasis and larger tumors. In conclusion, the present study revealed that Lin28 expression served as a risk factor for lymph node metastasis. Accordingly, Lin28 expression may be used as a prognostic marker to predict lymph node metastasis in patients with PTC. In addition, Lin28 may serve as a therapeutic target in the management of this tumor type, which may help improve patient outcomes.