甲状腺乳头状癌颈部中央区淋巴结转移数目对颈侧区淋巴结转移的预测价值  

Number of positive central cervical lymph nodes for predicting lateral cervical lymph node metastasis in patients with papillary thyroid carcinoma

作　　者：蔡业丰 陈恩东[1] 倪纯珏 李权[1] 曾瑞超[1] 张筱骅[1] 

机构地区：[1]温州医科大学附属第一医院肿瘤外科,325000 [2]温州医科大学附属第一医院麻醉科,325000

出　　处：《中华肿瘤杂志》2015年第8期628-631,共4页Chinese Journal of Oncology

基　　金：国家863高科技术研究发展计划（2012AA02A210）

摘　　要：目的探讨甲状腺乳头状癌（PTC）颈部中央区淋巴结转移数目对颈侧区淋巴结转移的预测价值。方法2005年1月至2010年10月间收治的、经病理证实的133例PTC患者，均接受颈部中央区淋巴结及颈侧区淋巴结清扫术，将颈部中央区淋巴结转移数目与颈侧区淋巴结转移进行定量分析。结果颈部中央区淋巴结转移预测颈侧区淋巴结转移的敏感度为84．7％（61／72），阳性预测值为66．3％（61／92）。颈部中央区淋巴结转移数目与颈侧区淋巴结转移有关（r=0．911，P=0．004）。颈部中央区淋巴结转移〈2枚和≥2枚患者的颈侧区淋巴结转移发生率分别为54．5％（12／22）和70．0％（49／70），差异无统计学意义（P=0．181）；〈3枚和≥3枚患者的颈侧区淋巴结转移发生率分别为50．0％（19／38）和77．8％（42／54），差异有统计学意义（P=0．006）；〈4枚和≥4枚患者的颈侧区淋巴结转移发生率分别为55．1％（27／49）和79．1％（34／43），差异有统计学意义（P=0．015）；〈5枚和≥5枚患者的颈侧区淋巴结转移发生率分别为57．6％（34／59）和81．8％（27／33），差异有统计学意义（P=0．019）；〈6枚和≥6枚患者的颈侧区淋巴结转移发生率分别为60．0％（39／65）和81．5％（22／27），差异有统计学意义（P=0．047）。结论PTC患者颈部中央区淋巴结转移与颈侧区转移存在密切关系，颈侧区淋巴结转移主要出现在颈部中央区淋巴结转移数目≥3枚时。当PTC患者颈部中央区淋巴结转移数目≥3枚时，可作为预测颈侧区淋巴结转移的一个量化指标，考虑施行颈侧区淋巴结清扫术。Objective The aim of this study was to evaluate the number of central cervical lymph node metastasis （CCLNM） in predicting lateral cervical lymph node metastasis （LCLNM） in patients with papillary thyroid carcinoma （PTC）. Methods From January 2005 to October 2010, a total of 133 patients diagnosed as PTC underwent central and lateral cervical lymph node dissection were enrolled in this study. Quantitative analysis was performed to explore the correlation between the number of CCLNM and LCLNM. Results The sensitivity of central cervical node metastasis to predict lateral cervical node metastasis was 84.7%（61/72）, and the positive predictive value （PPV） was 66.3% （61/92）. The incidence of lateral cervical LNM was correlated with the number of CCLNM（r= 0.911, P= 0.004）. The LCLNM rates in patients with number of CCLNM 〈2 and ≥2 were 54.5% （12/22） and 70.0% （49/70）, respectively, with a non-significant difference （P= 0.181 ）. The LCLNM rates in patients with number of CCLNM 〈3 and ≥〉 3 were 50.0% （19/38） and 77.8% （ 42/54）, showing a significant difference （ P = 0.006）. The LCLNM rates in patients with number of CCLNM 〈4 and ≥4 were 55.1% （27/49） and 79.1% （34/43）, with a significant difference （P= 0.015）. The LCLNM rates in patients with number of CCLNM 〈5 and ≥ 5 with the LLNM rate were 57.6% （34/59） and 81.8% （27/33） , showing a significant difference （P = 0.019）. The LCLNM rates in patients with number of CCLNM 〈6 and ≥6 were 60.0% （39/65） and 81.5% （22/ 27） , showing a significant difference （P = 0.047）. Conclusions CCLNM has a significant association with LCLNM in patients with papillary thyroid carcinoma. LCLNM is mainly observed in patients with≥ 3CCLNM. Therefore, the number of CLNM ≥3 may be a valuable predictor of lateral cervical lymph node metastasis, and lateral cervical lymph node dissection should be considered.

关 键 词：甲状腺肿瘤 淋巴结 淋巴转移 颈淋巴结清扫术 

分 类 号：R736.1[医药卫生—肿瘤]