喉前淋巴结转移在甲状腺乳头状癌中的临床意义  

Clinical significance in Delphian lymph node metastasis in papillary thyroid carcinoma

作　　者：尹新璐 陈博婕 莫嘉寅 吴斌[2] 徐雅男[1] 王家东[1] YIN Xinlu;CHEN Bojie;MO Jiayin;WU Bin;XU Yanan;WANG Jiadong(Department of Head and Neck Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200001,China;Department of General Surgery,Baoshan Branch,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200444,China)

机构地区：[1]上海交通大学医学院附属仁济医院头颈外科,上海200001 [2]上海交通大学附属仁济医院宝山分院普外科,上海200444

出　　处：《肿瘤》2021年第11期749-757,共9页Tumor

基　　金：国家自然科学基金资助项目(81900935);上海市扬帆计划(19YF1437600)。

摘　　要：目的:探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)喉前淋巴结(Delphian lymph node,DLN)转移的临床意义。方法:回顾性分析2019年11月—2021年3月的426例PTC患者DLN转移情况。结果:DLN检出率为59.9%,转移率为21.8%。DLN转移与肿瘤大小、双侧癌、肿瘤位置、中央区以及侧区淋巴结转移相关。肿瘤大小(≥1cm)(P=0.003)、双侧癌(P<0.001)、峡部癌(P=0.021)以及侧区淋巴结转移(P<0.001)是DLN转移的独立危险因素。DLN预测中央区和侧区淋巴结转移的指标如下:敏感度分别为25.9%和45.3%,特异度分别为85.5%和81.8%,阳性预测值分别为76.3%和31.2%,阴性预测值分别为39.0%和86.5%,阳性似然比分别为1.74和2.49,阴性似然比分别为0.87和0.67。在DLN转移患者中,29例进行侧区淋巴结清扫,最易转移至Ⅲ区淋巴结,其次是Ⅳ区和Ⅱ区。结论:DLN转移预示中央区以及侧颈区淋巴结转移可能性较高,应重视并仔细清扫喉前区域以便尽早干预,减少淋巴结转移复发,提高患者生存率。Objective:To investigate clinical significance of Delphian lymph node(DLN)metastasis in papillary thyroid carcinoma(PTC).Methods:This was a retrospective cohort study.The clinical pathological features and metastatic risks were statistically analyzed by reviewing 426 patients with PTC,who received their first operation and DLN dissection in our department during November 2019 to March 2021.Results:Of the 426 patients included in the study,DLN was detected in 255 patients(59.9%),and among whom,93 patients(21.8%)had confirmed DLN metastasis.In univariate analysis,DLN metastasis was correlated with tumor size(≥1cm),whether bilateral cancer or not,tumor location,CLNM(central lympg node metastasis,CLNM)and LLNM(Lateral lymph node metastasis,LLNM).But was not correlated with sex distribution,age,multifocality,preoperative TSH level,thyroiditis,and BRAF mutation.Multivariate analysis showed that tumor size(P=0.003),bilateral caner(P<0.001),isthmus cancer(P=0.021)and LLNM(P<0.001)were independent risk factors of DLN metastasis in PTC.DLN involvement was mildly predictive of CLNM(sensitivity=25.9%,specificity=85.5%,positive predictive values=76.3%,negative predictive values=39.0%,positive likelihood ratio=1.74,negative likelihood ratio=0.87),moderately predictive of LLNM(sensitivity=45.3%,specificity=81.8%,positive predictive values=31.2%,negative predictive values=86.5%,positive likelihood ratio=2.49,negative likelihood ratio=0.67).Of the 29 patients with DLN metastasis who underwent lateral lymph node dissection,levelⅢwas the most frequently involved(72.41%),followed by levelⅣ(55.17%),and levelⅡ(44.83%).Conclusion:DLN metastasis implies a higher possibility of CLNM and LLNM,we should carefully examine and remove any obvious lymphoid tissue in the prelaryngeal region during the initial operation to prevent the need for a reoperation with its potential risks.

关 键 词：喉前淋巴结 甲状腺乳头状癌 中央区淋巴结转移 侧区淋巴结转移 

分 类 号：R73[医药卫生—肿瘤]