Explore the sweeping strategy of cervical lymph node metastasis in papillary thyroid carcinoma once again_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Qinglin , SHEN Haoyuan ,  HU Chaohua

Department of Thyroid and Breast Surgery, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432100, P. R. China;

Corresponding?author：

HU Chaohua, Email: huchaohua2006@126.com

Keywords：

papillary thyroid carcinoma; lymph node metastasis; risk factor; number of risk factor

DOI：

10.7507/1007-9424.201905054

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the influencing factors of cervical lymph node metastasis of papillary thyroid carcinoma (PTC) and provide more accurate guidance for the cleaning strategy of PTC cervical lymph node.Methods Retrospectively analyzed the case data of pathological diagnosis of PTC patients from June 2013 to June 2019 in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, and explored the influencing factors of lymph node metastasis in central region and lymph node metastasis in lateral cervical region.Results The results of multivariate analysis showed that patients aged ≤55 years old, tumor diameter >1 cm, peripheral invasion, bilateral cancer, and multifocal cancer had a higher lymph node metastasis rate in the central region (P<0.05). When the number of risk factors mentioned above was 0, 1, 2, 3, 4, 5 and 6, the lymph node metastasis rate in the central region was respectively: 3.5% (4/113), 25.2% (72/286), 30.0% (70/233), 38.6% (76/197), 52.5% (53/101), 76.9% (20/26), and 100% (13/13). With the increase of the number of risk factors, the lymph node metastasis rate in central region increased (χ²=236.894, P<0.001). In the lymph node metastasis in lateral cervical region, multivariate analysis showed that patients with tumor diameter >1 cm, membranous invasion, and lymph node metastasis in the central region ≥2 had a higher lymph node metastasis rate (P<0.05), while lymph node metastasis in the lateral cervical region was not related to age, gender, peripheral invasion, and multifocal carcinoma (P>0.05). When the cumulative number of risk factors in patients was 0, 1, 2, 3, 4, 5, and 6, the lymph node metastasis rate in the lateral cervical region was respectively: 11.1% (1/9), 29.4% (5/17), 79.2% (19/24), 89.6% (43/48), 96.4% (27/28), 100% (21/21), and 100% (3/3). With the increase in the number of risk factors, lymph node metastasis in the lateral cervical region increased (χ²=101.094, P<0.001).Conclusions The cervical lymph node metastasis is positively correlated with the number of corresponding risk factors. With the increase of risk factors, cervical lymph node metastasis rate also increases. The number of risk factors provides a simple and intuitive indicator for cervical lymph node metastasis, which is more conducive to the formulation of individualized and accurate surgical program.

Citation： WU Qinglin, SHEN Haoyuan, HU Chaohua. Explore the sweeping strategy of cervical lymph node metastasis in papillary thyroid carcinoma once again. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1417-1423. doi: 10.7507/1007-9424.201905054 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	鄭榮壽, 孫可欣, 張思維, 等. 2015 年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2019, 41(1): 19-28.
3.	Tufano RP, Noureldine SI, Angelos P. Incidental thyroid nodules and thyroid cancer: considerations before determining management. JAMA Otolaryngol Head Neck Surg, 2015, 141(6): 566-572.
4.	肖海鵬, 洪澍彬, 喻爽. 甲狀腺癌流行趨勢及其影響因素. 內科理論與實踐, 2013, 8(6): 383-386, 387.
5.	中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華核醫學與分子影像雜志, 2013, 33(2): 96-115.
6.	Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg, 2002, 128(7): 751-758.
7.	Lepoutre-Lussey C, Maddah D, Golmard JL, et al. Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement. Eur J Endocrinol, 2014, 170(6): 837-846.
8.	邵堂雷, 王振乾, 蔣曉, 等. 甲狀腺再次手術中喉返神經保護研究(附 163 例分析). 中國實用外科雜志, 2015, 35(6): 656-658.
9.	Raffaelli M, De Crea C, Sessa L, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery, 2012, 152(6): 957-964.
10.	Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
11.	安祥, 余丹, 李兵. 預防性中央區淋巴結清掃對甲狀腺微小乳頭狀癌患者預后影響的Meta分析. 臨床耳鼻咽喉頭頸外科雜志, 2019, 33(2): 138-142.
12.	劉文, 程若川. 甲狀腺乳頭狀癌中央區淋巴結轉移的預測因素. 中國普外基礎與臨床雜志, 2018, 25(1): 99-103.
13.	Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more " personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
14.	廖銘興, 張迪天, 楊先榮. 乳頭狀甲狀腺微小癌頸部中央組淋巴結的轉移規律及影響因素分析. 中國醫師進修雜志, 2014, 37(26): 51-53.
15.	邊學海, 李世杰, 張廣, 等. 甲狀腺微小乳頭狀癌頸淋巴結轉移影響因素的初步研究(附 1 180 例報道). 國際外科學雜志, 2013, 40(2): 105-108.
16.	高慶軍, 王南鵬, 趙代偉. cN0 期甲狀腺乳頭狀微小癌中央區淋巴結隱性轉移危險因素. 中國普通外科雜志, 2015, 24(11): 1504-1510.
17.	劉文, 程若川, 蘇艷軍, 等. 2015 版美國甲狀腺協會指南 cN0 甲狀腺乳頭狀癌手術方案合理性分析. 中國實用外科雜志, 2017, 37(5): 568-571, 576.
18.	Kim KE, Kim EK, Yoon JH, et al. Preoperative prediction of central lymph node metastasis in thyroid papillary microcarcinoma using clinicopathologic and sonographic features. World J Surg, 2013, 37(2): 385-391.
19.	吳紅偉, 沈豐, 孫少華, 等. 全甲狀腺切除+預防性中央區淋巴結清掃術治療多灶性甲狀腺乳頭狀癌 103 例臨床分析. 中國普外基礎與臨床雜志, 2016, 23(3): 324-327.
20.	王偉斌, 蘇星韻, 阮佳瑩, 等. 2 682 例甲狀腺乳頭狀癌臨床病理及預后分析. 中華普通外科雜志, 2018, 33(5): 393-397.
21.	吳昕, 徐協群, 鄭朝紀, 等. 分化型甲狀腺癌再次手術的臨床分析. 中國普外基礎與臨床雜志, 2017, 24(7): 813-818.
22.	王彬, 郭泰. 甲狀腺乳頭狀癌頸側區淋巴結轉移相關影響因素分析. 山西醫科大學學報, 2019, 50(2): 202-205.
23.	張潤方, 張松濤, 龔文博, 等. cN0 期甲狀腺乳頭狀癌側頸淋巴結轉移影響因素. 中華內分泌外科雜志, 2017, 12(6): 509-512.
24.	Zeng RC, Zhang W, Gao EL, et al. Number of central lymph node metastasis for predicting lateral lymph node metastasis in papillary thyroid microcarcinoma. Head Neck, 2014, 36(1): 101-106.
25.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
26.	Lee YS, Lim YS, Lee JC, et al. Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma: preliminary report. World J Surg, 2010, 34(11): 2558-2563.
27.	Hu D, Zhou J, He W, et al. Risk factors of lateral lymph node metastasis in cN0 papillary thyroid carcinoma. World J Surg Oncol, 2018, 16(1): 30.
28.	薛文丹, 邢孔麗, 李小清. 超聲檢查對甲狀腺乳頭狀癌早期頸部淋巴結轉移的診斷價值分析. 檢驗醫學與臨床, 2018, 15(6): 754-756, 760.
29.	張宏春, 耿喆. 高頻超聲聯合 FNAC 對甲狀腺乳頭狀癌頸部淋巴結轉移的診斷價值. 實用癌癥雜志, 2018, 33(11): 1869-1872.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 鄭榮壽, 孫可欣, 張思維, 等. 2015 年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2019, 41(1): 19-28.
3. Tufano RP, Noureldine SI, Angelos P. Incidental thyroid nodules and thyroid cancer: considerations before determining management. JAMA Otolaryngol Head Neck Surg, 2015, 141(6): 566-572.
4. 肖海鵬, 洪澍彬, 喻爽. 甲狀腺癌流行趨勢及其影響因素. 內科理論與實踐, 2013, 8(6): 383-386, 387.
5. 中華醫學會內分泌學分會, 中華醫學會外科學分會內分泌學組, 中國抗癌協會頭頸腫瘤專業委員會, 等. 甲狀腺結節和分化型甲狀腺癌診治指南. 中華核醫學與分子影像雜志, 2013, 33(2): 96-115.
6. Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg, 2002, 128(7): 751-758.
7. Lepoutre-Lussey C, Maddah D, Golmard JL, et al. Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement. Eur J Endocrinol, 2014, 170(6): 837-846.
8. 邵堂雷, 王振乾, 蔣曉, 等. 甲狀腺再次手術中喉返神經保護研究(附 163 例分析). 中國實用外科雜志, 2015, 35(6): 656-658.
9. Raffaelli M, De Crea C, Sessa L, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery, 2012, 152(6): 957-964.
10. Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
11. 安祥, 余丹, 李兵. 預防性中央區淋巴結清掃對甲狀腺微小乳頭狀癌患者預后影響的Meta分析. 臨床耳鼻咽喉頭頸外科雜志, 2019, 33(2): 138-142.
12. 劉文, 程若川. 甲狀腺乳頭狀癌中央區淋巴結轉移的預測因素. 中國普外基礎與臨床雜志, 2018, 25(1): 99-103.
13. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more " personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
14. 廖銘興, 張迪天, 楊先榮. 乳頭狀甲狀腺微小癌頸部中央組淋巴結的轉移規律及影響因素分析. 中國醫師進修雜志, 2014, 37(26): 51-53.
15. 邊學海, 李世杰, 張廣, 等. 甲狀腺微小乳頭狀癌頸淋巴結轉移影響因素的初步研究(附 1 180 例報道). 國際外科學雜志, 2013, 40(2): 105-108.
16. 高慶軍, 王南鵬, 趙代偉. cN0 期甲狀腺乳頭狀微小癌中央區淋巴結隱性轉移危險因素. 中國普通外科雜志, 2015, 24(11): 1504-1510.
17. 劉文, 程若川, 蘇艷軍, 等. 2015 版美國甲狀腺協會指南 cN0 甲狀腺乳頭狀癌手術方案合理性分析. 中國實用外科雜志, 2017, 37(5): 568-571, 576.
18. Kim KE, Kim EK, Yoon JH, et al. Preoperative prediction of central lymph node metastasis in thyroid papillary microcarcinoma using clinicopathologic and sonographic features. World J Surg, 2013, 37(2): 385-391.
19. 吳紅偉, 沈豐, 孫少華, 等. 全甲狀腺切除+預防性中央區淋巴結清掃術治療多灶性甲狀腺乳頭狀癌 103 例臨床分析. 中國普外基礎與臨床雜志, 2016, 23(3): 324-327.
20. 王偉斌, 蘇星韻, 阮佳瑩, 等. 2 682 例甲狀腺乳頭狀癌臨床病理及預后分析. 中華普通外科雜志, 2018, 33(5): 393-397.
21. 吳昕, 徐協群, 鄭朝紀, 等. 分化型甲狀腺癌再次手術的臨床分析. 中國普外基礎與臨床雜志, 2017, 24(7): 813-818.
22. 王彬, 郭泰. 甲狀腺乳頭狀癌頸側區淋巴結轉移相關影響因素分析. 山西醫科大學學報, 2019, 50(2): 202-205.
23. 張潤方, 張松濤, 龔文博, 等. cN0 期甲狀腺乳頭狀癌側頸淋巴結轉移影響因素. 中華內分泌外科雜志, 2017, 12(6): 509-512.
24. Zeng RC, Zhang W, Gao EL, et al. Number of central lymph node metastasis for predicting lateral lymph node metastasis in papillary thyroid microcarcinoma. Head Neck, 2014, 36(1): 101-106.
25. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
26. Lee YS, Lim YS, Lee JC, et al. Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma: preliminary report. World J Surg, 2010, 34(11): 2558-2563.
27. Hu D, Zhou J, He W, et al. Risk factors of lateral lymph node metastasis in cN0 papillary thyroid carcinoma. World J Surg Oncol, 2018, 16(1): 30.
28. 薛文丹, 邢孔麗, 李小清. 超聲檢查對甲狀腺乳頭狀癌早期頸部淋巴結轉移的診斷價值分析. 檢驗醫學與臨床, 2018, 15(6): 754-756, 760.
29. 張宏春, 耿喆. 高頻超聲聯合 FNAC 對甲狀腺乳頭狀癌頸部淋巴結轉移的診斷價值. 實用癌癥雜志, 2018, 33(11): 1869-1872.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Explore the sweeping strategy of cervical lymph node metastasis in papillary thyroid carcinoma once again

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content