摘要
背景与目的:甲状腺乳头状癌(papillary thyroid carcinoma,PTC)常发生颈部淋巴结转移,多见于颈部中央区。该研究旨在探讨转移淋巴结数小于等于5枚的p N1a PTC患者颈部中央区淋巴结清扫数与^(131)Ⅰ"清甲"治疗后临床转归的关系。方法:回顾性分析2012年2月—2014年12月北京协和医院收治的167例经术后病理证实存在1~5枚淋巴结转移的p N1a PTC患者的临床资料,均行全甲状腺切除或近全甲状腺切除联合中央区淋巴结清扫术。经过^(131)Ⅰ"清甲"治疗后中位随访26个月,将患者的临床转归根据美国甲状腺协会(American Thyroid Association,ATA)2015年发布的《成人甲状腺结节与分化型甲状腺癌诊治指南》分为:满意(excellent response,ER)、不确切(indeterminate response,IDR)、血清学反应欠佳(biochemical incomplete response,BIR)和影像学反应欠佳(structural incomplete response,SIR)。计算不同淋巴结清扫数对应的累计ER率(以ERn表示,n为淋巴结清扫数,ERn为清扫数小于等于n枚淋巴结后达到ER的患者数占清扫数小于等于n枚淋巴结的总人数的百分比),分析中央区淋巴结清扫数与ERn的关系。结果:随着中央区淋巴结清扫数增多,ERn总体呈上升趋势,ER1、ER5、ER10和ER30分别为25.0%、66.7%、74.7%和79.1%,且n由1至10时ERn升高明显。n大于等于10的患者的满意率高于n小于10的患者,差异有统计学意义(85.7%vs 73.3%,P=0.05)。多因素Logistic回归分析显示,中央区淋巴结清扫数大于等于10枚(OR=2.720,95%CI:1.052~7.033,P=0.039)、^(131)Ⅰ治疗前刺激性甲状腺球蛋白(stimulated thyroglobulin,s Tg)水平(OR=0.955,95%CI:0.926~0.984,P=0.003)是影响ER的独立预后因素。结论:随着中央区淋巴结清扫数的增多,p N1a PTC患者^(131)Ⅰ"清甲"治疗后更易达到ER;对于淋巴结转移数小于等于5枚的p N1a PTC患者,中央区淋巴结清扫数大于等于10枚有助于其^(131)Ⅰ"清甲"治疗后达到ER。
Background and purpose： Neck lymph node metastasis, most of which presents in central neck compartment, is common in patients with papillary thyroid carcinoma （PTC）. The objective of this study was to investigate the relationship between the number of dissected central neck lymph nodes and clinical outcome after radioactive iodine （RAI） ablation in pNl. PTC with no more than 5 lymph nodes involvement. Methods： A total of 167 PFC patients who had 1-5 proven metastatic lymph nodes according to postoperative pathological diagnosis were retrospectively analyzed, all of whom underwent total or near total thyroidectomy and central lymph node dissection. After a median follow-up period of 26 months, the clinical outcome of each patient was evaluated as excellent response （ER）, indeterminate response （IDR）, bio- chemical incomplete response （BIR）, or structural incomplete response （SIR） according to the new American Thyroid As- sociation guidelines. The accumulative ER rate （ERn） was calculated in patients with different numbers of dissected lymph nodes （ERn was defined as the proportion of patients who achieved ER with the dissected lymph node number of ≤n）. The relationship between the number of dissected central neck lymph nodes and ERn were investigated. Results： As the increase in the number of dissected central neck lymph nodes, there was also an overall increase in ERn, especially when n rose from 1 to 10. The values of ER1, ER5, ER10 and ER30 were 25.0%, 66.7%, 74.7% and 79.1%, respectively. Besides, the proportion of patients who achieved ER was higher in those with 10 or more dissected lymph nodes than in those with less than 10 （85.7% vs 73.3%, P=0.05）. In the multivariate logistic regression analysis, both the dissected central lymph node number of ≥ 10 （OR=2.720, 95%CI： 1.052-7.033, P=0.039） and the level of preablation stimulated thyroglobulin （OR=0.955, 95%CI： 0.926-0.984, P=0.003） were shown to contribute independently to ER. Conclusion： As the increasing number of dissected central neck lymph nodes, the percentage of pNia PTC patients that achieved ER after RAI ablation generally rises. In pN1a PTC patients with no more than 5 lymph nodes involvement, a central compartment dissection with 10 or more lymph nodes might help them achieve ER after RAI ablation.
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2017年第4期256-261,共6页
China Oncology
基金
国家自然科学基金(81571714)
卫生部行业科研专项项目(201202012)
关键词
甲状腺乳头状癌
颈淋巴结清扫术
临床转归
淋巴结转移
Papillary thyroid carcinoma
Neck lymph node dissection
Clinical outcome
Lymph node metastasis
