颈部淋巴结转移与甲状腺乳头状癌的治疗及预后

颈部淋巴结转移在甲状腺乳头状癌中较为普遍.尽管颈部淋巴结转移可独立预测甲状腺乳头状癌的复发,但其对于肿瘤预后的影响仍有争议.预防性中央区淋巴结对甲状腺乳头状癌患者的价值尚不清楚,尤其是术前无颈部淋巴结转移的临床或影像学证据时.对于存在危险因素的甲状腺乳头状癌患者,如男性、年龄大于45岁、肿瘤直径＞4 cm、多灶性和甲状腺外侵犯以及BRAF基因突变阳性等,术前应认真评估颈部淋巴结,必要时可行预防性中央区淋巴结清扫.

Treatment and prognosis of papillary thyroid cancer with cervical lymph node metastasis

Lymph nodes metastasis in the neck is common in papillary thyroid cancer.Although the presence of lymph nodes metastasis is an independent predictor for recurrence,its significance is controversial and may have little prognostic significance.The role of prophylactic central neck dissection (pCND) for patients with papillary thyroid cancer is unclear,particularly when there are no clinical or radiological evidence of cervical lymph node metastasis.In patients who are deemed high risk including male sex,age ＞ 45years,tumour diameter greater than 4 cm,extracapsular,extrathyroidal disease,or positive BRAF mutation,a comprehensive evaluation of cervical lymph node should be considered,and pCND may be performed if necessary.