甲状腺乳头状癌cN0患者中央区淋巴转移的研究

目的 探讨临床淋巴结阴性(cNO)甲状腺乳头状癌患者中央区(Ⅵ区)淋巴转移规律及清扫的临床价值.方法 回顾性分析中国医学科学院肿瘤医院头颈外科2003年1月至2006年12月初治的cNO甲状腺乳头状癌并行中央区淋巴清扫的108例患者临床资料.研究患者性别、年龄、肿瘤多中心病灶、被膜外侵、肿瘤大小、部位与中央区淋巴转移的关系.影响中央区淋巴转移率单因素差异比较采用 x2检验,Logistic模型进行多因素分析,Kaplan-Meier法计算生存率、颈侧复发率和远处转移率.结果 cNO甲状腺乳头状癌中央区淋巴转移率为59.2%(64/108),年龄小于45岁、甲状腺被膜受侵、肿瘤直径＞3 cm是中央区淋巴转移的独立危险因素(比值比分别为5.514、5.610和3.122,P值均＜0.05).本组中央区淋巴清扫喉返神经暂时性麻痹发生率为1.8%(2/108).术后暂时性低钙发生率为4.6%(5/108),永久性低钙发生率为0.9%(1/108).中位随访时间53个月,6例患者颈侧复发转移,2例局部复发,其中1例患者局部复发后死亡.5年颈侧复发率、生存率分别为4.8%、99.1%.结论 cNO甲状腺乳头状癌中央区淋巴转移率高,中央区淋巴清扫术后并发症的发生率低,建议对cNO甲状腺乳头状癌患者行中央区淋巴清扫.

Central compartment lymph node metastasis in cN0 papillary thyroid carcinoma

Objective To evaluate the incidence and the predictive factors for the metastasis of central compartment lymph nodes ( level Ⅵ ) in clinically node-negative (cNO) papillary thyroid carcinoma (PTC). Methods One hundred and eight patients with cNO PTC underwent neck dissection for level Ⅵ between January 2003 and December 2006 were followed up and analyzed retrospectively. Univariate analysis with the x2 test was used to analyze the statistical correlation between central compartment lymph nodes metastasis and the other clinical factors. Multiple Logistic regression analysis was used to identify the multivariate correlates of central compartment metastasis. Kaplan-Meier method was used to calculate the accumulative survival rate, lateral neck recurrence and metastasis rate. Results Metastasis rate in level Ⅵ was 59. 2% (64/108). Age below 45, tumor size ＞ 3 cm and extracapsular spread were independent predictive factors for the metastasis in level Ⅵ (odds ratio were 5.514, 5.610 and 3. 122, P ＜ 0. 05,respectively). There were low incidence of postoperative complications, 2 cases with transient nerve palsy (1. 8%), 5 cases with transient hypoparathyroidism (4. 6%) and 1 case with permanent hypoparathyroidism(0.9% ). Six cases with ipsilateral neck recurrence, 1 case died. The 5-year lateral neck recurrence rate and accumulative survival rate were 4. 8% and 99. 1% respectively. Conclusion Metastasis in level Ⅵ in the patients with cNO PTC is common and selective neck dissection is necessary for the patients.