Analysis of the patterns of cervical lymph node recurrence in patients with cN0 papillary thyroid carcinoma after central neck lymph node dissection
10.3760/cma.j.issn.0253-3766.2015.10.012
- VernacularTitle:淋巴结临床阴性甲状腺乳头状癌中央区淋巴结清扫后颈部复发模式分析
- Author:
Hui HUANG
1
;
Zhengang XU
;
Xiaolei WANG
;
Yuehuang WU
;
Shaoyan LIU
Author Information
1. 100021,中国医学科学院 北京协和医学院肿瘤医院头颈外科
- Keywords:
Thyroid neoplasms;
Carcinoma,papillary;
Lymphatic metastasis;
Neck dissection
- From:
Chinese Journal of Oncology
2015;(10):771-775
- CountryChina
- Language:Chinese
-
Abstract:
Objective To retrospectively analyze the long?term results of prophylactic central lymph node dissection in cN0 papillary thyroid carcinoma ( PTC), and investigate the treatment method of the cervical lymph nodes for cN0 PTC. Methods One hundred and thirty?six patients with cN0 PTC were treated by surgery at the Cancer Hospital of Chinese Academy of Medical Sciences from 2000 to 2006. Their clinicopathological characteristics, surgical procedures and survival outcomes were collected and analyzed. Results The occult lymph node metastasis rate in central compartment was 61.0%. The average number of positive lymph nodes was 2.47 (1?13), in which 54 patients had 1?2 and 29 patients had≥3 positive lymph nodes. Multiple logistic regression analysis showed that age less than 45 ( P=0. 001, OR 3. 571, 95% CI 1.681?7.587) and extracapsular spread ( ECS) ( P=0.015,OR 2.99, 95% CI 1.241?7.202) were independent risk factors for lymph node metastasis in the central compartment. The ten?year cumulative overall survival rate was 98. 3% and cumulative lateral neck metastasis rate was 25. 2%. Multivariate analysis with Cox regression model showed that ECS( P=0.001,OR 5.211, 95% CI1.884?14.411) and positive lymph nodes in the central compartment≥3 ( P=0.009,OR 4.005, 95% CI 1.419?11.307) were independent risk factors for lymph node recurrence in the lateral neck region. The distribution of recurrent lymph nodes: level Ⅳ(82.4%), level Ⅲ (64.7%), level Ⅱ (29.4%) and level Ⅴ (11.8%). Conclusions Routine central lymph node dissection, at least unilateral, should be conducted for cN0 papillary thyroid carcinoma. Attention should be paid to the treatment of lateral neck region in patients with cN0 papillary thyroid carcinoma. Selective neck dissection is suggested for cN0 PTC with ECS or positive central lymph nodes≥3, or both. The range of dissection should include level Ⅲ and Ⅳ at least.
