Delphian淋巴结转移在甲状腺乳头状癌中的临床意义  

The clinical significance of Delphian lymph node metastasis in papillary thyroid cancer

作　　者：郑桂彬[1] 郝少龙[1] 刘新承 宁进尧[1] 吴国长[1] 王东[1] 李宝元[1] 姜立新[1] 宋西成[2] 郑海涛[1] 

机构地区：[1]青岛大学附属烟台毓璜顶医院甲状腺外科,264000 [2]青岛大学附属烟台毓璜顶医院耳鼻咽喉头颈外科,264000

出　　处：《中华耳鼻咽喉头颈外科杂志》2016年第11期842-845,共4页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

基　　金：山东省自然科学基金（ZR2015HL092）;山东省重点研发计划（2015DSF118090）;山东省留学人员择优资助项目（2013-528）

摘　　要：目的 探讨Delphian淋巴结（Delphian lymph node,DLN）转移在甲状腺乳头状癌中的临床意义.方法 回顾性分析2015年1月至12月所有甲状腺癌患者共505例,将208例病理诊断为甲状腺乳头状癌且病理报告中明确标明喉前淋巴结检测情况的病例进行统计分析.结果 208例患者中,Delphian淋巴结检出率63.0％,转移率21.4％;Delphian淋巴结转移与多灶（P=0.038）、肿瘤直径〉1 cm（P =0.001）、BRAFV600E基因突变（P=0.017）及中央区淋巴结转移（P〈0.001）有关;肿瘤直径〉1 cm（95％CI 1.308-9.909,OR=3.600,P=0.013）及中央区淋巴结转移数目（95％ CI1.313-2.163,OR=1.685,P〈0.001）是DLN转移的独立危险因素;DLN转移患者发生中央区淋巴结转移的可能性增加8.8倍;DLN转移伴侧颈转移患者较不伴转移患者更易出现中央区淋巴结转移（6.5±3.0比1.5±0.7,P=0.009）,6例中有5例为多灶并伴有BRAFV600E基因突变.结论 Delphian淋巴结转移预示着中央区淋巴结及侧颈部淋巴结转可能性增高,应术中评估Delphian淋巴结情况以指导区域淋巴结清扫及术后治疗随访策略.Objective To evaluate the clinical significance of Delphian lymph node （DLN） metastasis in papillary thyroid cancer （PTC）.Method A total of 505 cases with PTC confirmed pathologically in our hospital between January 2015 and December 2015 were retrospectively reviewed.208 patients with DLN assessed separately by histopathologic examination who underwent primary surgery for PTC were included for the following analysis.Results In 208 patients,the detection rate of DLN was 63.0% and the metastasis rate of DLN was 21.4%.DLN metastasis was correlated with PTC muhifocality （P =0.038）,tumor size over lcm （P =0.001）,BRAFV600E mutation （P =0.017） and central neck node metastasis （P 〈 0.001）.Tumor size over 1 cm （95% CI 1.308-9.909,OR =3.600,P =0.013） and the number of node with central neck metastasis （95% CI 1.313-2.163,OR =1.685,P 〈 0.001） were independent risk factors for DLN metastasis.The presence of DLN metastasis was associated with an 8.8-fold higher frequency of central neck node metastasis compared to cases without DLN metastasis.Among patients with DLN metastases,central lymph node metastasis was more common in the cases with lateral neck node metastases compared to those without lateral neck node metastases （6.5 ± 3.0 vs 1.5 ± 0.7,P =0.009）,and 5 of the 6 patients also presented with PTC multifocality and BRAFV600E mutation.Conclusion DLN metastasis implies a higher possibility of central neck lymph node metastasis.DLN should be assessed during operation to provide information for neck dissection,post-operative administration and follow-up strategy.

关 键 词：甲状腺乳头状癌 喉前淋巴结 淋巴结转移 

分 类 号：R736.1[医药卫生—肿瘤]