cN1b甲状腺乳头状癌V区淋巴结转移特点及相关因素探索

目的探讨cNlb甲状腺乳头状癌V区淋巴结转移特点及其预测因素。方法回顾性分析2005年6月至2010年6月汕头大学医学院附属肿瘤医院接受治疗性颈清扫（Ⅱ～V区）的cNlb且V区临床阴性的甲状腺乳头状癌93例的临床资料，颈清扫淋巴结标本按颈部分区收集并送术后常规病理检查。结果93例中，Ⅱ、Ⅲ、Ⅳ及V区淋巴结转移率分别为58．1％（54／93）、68．8％（64／93）、73．1％（68／93）和16．1％（15／93），多因素分析显示Ⅱ～V区同时转移与否是影响V区淋巴结转移的危险因素（32．3％VS7．3％，OR=4．3，P=0．027）。结论术中冰冻切片或术前CT评价Ⅱ～Ⅳ区非同时阳性时，cN1b且V区临床阴性甲状腺乳头状癌患者无需常规行V区清扫。

Level V lymph node metastasis in patients with cN1b papillary thyroid carcinoma

Objective To evaluate the frequency and pattern of level V lymph nodes （LNs）metastasis and to identify the risk factors for level V LNs in papillary thyroid carcinoma （PTC）patients with positive lateral neck LNs. Methods 93 cases with PTC undergoing therapeutic lateral neck dissection （level Ⅱ-Ⅴ） from Jun. 2005 to Jun. 2010 were retrospectively reviewed. Neck dissection specimens were obtained for histological analysis of LNs metastasis. Results LNs metastasis rate was 58.1% （54/93） , 68.8% （64/93）, 73.1% （68/93） and 16.1% （15/93） respectively in level Ⅱ , Ⅲ, Ⅳ and Ⅴ. Occult metastasis in level V was observed in 15 （16.1%） patients. Multivariate analysis showed lymphatic metastasis with or without simultaneous multilevel involvement （level Ⅱ , Ⅲ, and Ⅳ） was associated with level Ⅴ metastasis （32.3% vs 7.3%, OR =4.3, P = 0. 027 ）. Conclusions Level V lymph nodes dissection can be omitted in the treatment of PTC patients if simultaneous multilevel involvement （ level Ⅱ , Ⅲ, and Ⅳ） of lymphatic metastasis is not found by histological examination or CT scan.