Explore the sweeping strategy of cervical lymph node metastasis in papillary thyroid carcinoma once again_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WU Qinglin , SHEN Haoyuan ,  HU Chaohua

Department of Thyroid and Breast Surgery, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432100, P. R. China;

Corresponding author：

HU Chaohua, Email: huchaohua2006@126.com

Keywords：

papillary thyroid carcinoma; lymph node metastasis; risk factor; number of risk factor

DOI：

10.7507/1007-9424.201905054

Video：

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Objective To investigate the influencing factors of cervical lymph node metastasis of papillary thyroid carcinoma (PTC) and provide more accurate guidance for the cleaning strategy of PTC cervical lymph node.Methods Retrospectively analyzed the case data of pathological diagnosis of PTC patients from June 2013 to June 2019 in Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, and explored the influencing factors of lymph node metastasis in central region and lymph node metastasis in lateral cervical region.Results The results of multivariate analysis showed that patients aged ≤55 years old, tumor diameter >1 cm, peripheral invasion, bilateral cancer, and multifocal cancer had a higher lymph node metastasis rate in the central region (P<0.05). When the number of risk factors mentioned above was 0, 1, 2, 3, 4, 5 and 6, the lymph node metastasis rate in the central region was respectively: 3.5% (4/113), 25.2% (72/286), 30.0% (70/233), 38.6% (76/197), 52.5% (53/101), 76.9% (20/26), and 100% (13/13). With the increase of the number of risk factors, the lymph node metastasis rate in central region increased (χ²=236.894, P<0.001). In the lymph node metastasis in lateral cervical region, multivariate analysis showed that patients with tumor diameter >1 cm, membranous invasion, and lymph node metastasis in the central region ≥2 had a higher lymph node metastasis rate (P<0.05), while lymph node metastasis in the lateral cervical region was not related to age, gender, peripheral invasion, and multifocal carcinoma (P>0.05). When the cumulative number of risk factors in patients was 0, 1, 2, 3, 4, 5, and 6, the lymph node metastasis rate in the lateral cervical region was respectively: 11.1% (1/9), 29.4% (5/17), 79.2% (19/24), 89.6% (43/48), 96.4% (27/28), 100% (21/21), and 100% (3/3). With the increase in the number of risk factors, lymph node metastasis in the lateral cervical region increased (χ²=101.094, P<0.001).Conclusions The cervical lymph node metastasis is positively correlated with the number of corresponding risk factors. With the increase of risk factors, cervical lymph node metastasis rate also increases. The number of risk factors provides a simple and intuitive indicator for cervical lymph node metastasis, which is more conducive to the formulation of individualized and accurate surgical program.

Citation： WU Qinglin, SHEN Haoyuan, HU Chaohua. Explore the sweeping strategy of cervical lymph node metastasis in papillary thyroid carcinoma once again. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2019, 26(12): 1417-1423. doi: 10.7507/1007-9424.201905054 Copy

1.	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2.	郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3.	Tufano RP, Noureldine SI, Angelos P. Incidental thyroid nodules and thyroid cancer: considerations before determining management. JAMA Otolaryngol Head Neck Surg, 2015, 141(6): 566-572.
4.	肖海鹏, 洪澍彬, 喻爽. 甲状腺癌流行趋势及其影响因素. 内科理论与实践, 2013, 8(6): 383-386, 387.
5.	中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华核医学与分子影像杂志, 2013, 33(2): 96-115.
6.	Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg, 2002, 128(7): 751-758.
7.	Lepoutre-Lussey C, Maddah D, Golmard JL, et al. Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement. Eur J Endocrinol, 2014, 170(6): 837-846.
8.	邵堂雷, 王振乾, 蒋晓, 等. 甲状腺再次手术中喉返神经保护研究(附 163 例分析). 中国实用外科杂志, 2015, 35(6): 656-658.
9.	Raffaelli M, De Crea C, Sessa L, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery, 2012, 152(6): 957-964.
10.	Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
11.	安祥, 余丹, 李兵. 预防性中央区淋巴结清扫对甲状腺微小乳头状癌患者预后影响的Meta分析. 临床耳鼻咽喉头颈外科杂志, 2019, 33(2): 138-142.
12.	刘文, 程若川. 甲状腺乳头状癌中央区淋巴结转移的预测因素. 中国普外基础与临床杂志, 2018, 25(1): 99-103.
13.	Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more " personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
14.	廖铭兴, 张迪天, 杨先荣. 乳头状甲状腺微小癌颈部中央组淋巴结的转移规律及影响因素分析. 中国医师进修杂志, 2014, 37(26): 51-53.
15.	边学海, 李世杰, 张广, 等. 甲状腺微小乳头状癌颈淋巴结转移影响因素的初步研究(附 1 180 例报道). 国际外科学杂志, 2013, 40(2): 105-108.
16.	高庆军, 王南鹏, 赵代伟. cN0 期甲状腺乳头状微小癌中央区淋巴结隐性转移危险因素. 中国普通外科杂志, 2015, 24(11): 1504-1510.
17.	刘文, 程若川, 苏艳军, 等. 2015 版美国甲状腺协会指南 cN0 甲状腺乳头状癌手术方案合理性分析. 中国实用外科杂志, 2017, 37(5): 568-571, 576.
18.	Kim KE, Kim EK, Yoon JH, et al. Preoperative prediction of central lymph node metastasis in thyroid papillary microcarcinoma using clinicopathologic and sonographic features. World J Surg, 2013, 37(2): 385-391.
19.	吴红伟, 沈丰, 孙少华, 等. 全甲状腺切除+预防性中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌 103 例临床分析. 中国普外基础与临床杂志, 2016, 23(3): 324-327.
20.	王伟斌, 苏星韵, 阮佳莹, 等. 2 682 例甲状腺乳头状癌临床病理及预后分析. 中华普通外科杂志, 2018, 33(5): 393-397.
21.	吴昕, 徐协群, 郑朝纪, 等. 分化型甲状腺癌再次手术的临床分析. 中国普外基础与临床杂志, 2017, 24(7): 813-818.
22.	王彬, 郭泰. 甲状腺乳头状癌颈侧区淋巴结转移相关影响因素分析. 山西医科大学学报, 2019, 50(2): 202-205.
23.	张润方, 张松涛, 龚文博, 等. cN0 期甲状腺乳头状癌侧颈淋巴结转移影响因素. 中华内分泌外科杂志, 2017, 12(6): 509-512.
24.	Zeng RC, Zhang W, Gao EL, et al. Number of central lymph node metastasis for predicting lateral lymph node metastasis in papillary thyroid microcarcinoma. Head Neck, 2014, 36(1): 101-106.
25.	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
26.	Lee YS, Lim YS, Lee JC, et al. Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma: preliminary report. World J Surg, 2010, 34(11): 2558-2563.
27.	Hu D, Zhou J, He W, et al. Risk factors of lateral lymph node metastasis in cN0 papillary thyroid carcinoma. World J Surg Oncol, 2018, 16(1): 30.
28.	薛文丹, 邢孔丽, 李小清. 超声检查对甲状腺乳头状癌早期颈部淋巴结转移的诊断价值分析. 检验医学与临床, 2018, 15(6): 754-756, 760.
29.	张宏春, 耿喆. 高频超声联合 FNAC 对甲状腺乳头状癌颈部淋巴结转移的诊断价值. 实用癌症杂志, 2018, 33(11): 1869-1872.

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2018, 68(6): 394-424.
2. 郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3. Tufano RP, Noureldine SI, Angelos P. Incidental thyroid nodules and thyroid cancer: considerations before determining management. JAMA Otolaryngol Head Neck Surg, 2015, 141(6): 566-572.
4. 肖海鹏, 洪澍彬, 喻爽. 甲状腺癌流行趋势及其影响因素. 内科理论与实践, 2013, 8(6): 383-386, 387.
5. 中华医学会内分泌学分会, 中华医学会外科学分会内分泌学组, 中国抗癌协会头颈肿瘤专业委员会, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中华核医学与分子影像杂志, 2013, 33(2): 96-115.
6. Robbins KT, Clayman G, Levine PA, et al. Neck dissection classification update: revisions proposed by the American Head and Neck Society and the American Academy of Otolaryngology-Head and Neck Surgery. Arch Otolaryngol Head Neck Surg, 2002, 128(7): 751-758.
7. Lepoutre-Lussey C, Maddah D, Golmard JL, et al. Post-operative neck ultrasound and risk stratification in differentiated thyroid cancer patients with initial lymph node involvement. Eur J Endocrinol, 2014, 170(6): 837-846.
8. 邵堂雷, 王振乾, 蒋晓, 等. 甲状腺再次手术中喉返神经保护研究(附 163 例分析). 中国实用外科杂志, 2015, 35(6): 656-658.
9. Raffaelli M, De Crea C, Sessa L, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery, 2012, 152(6): 957-964.
10. Ito Y, Tomoda C, Uruno T, et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg, 2006, 30(1): 91-99.
11. 安祥, 余丹, 李兵. 预防性中央区淋巴结清扫对甲状腺微小乳头状癌患者预后影响的Meta分析. 临床耳鼻咽喉头颈外科杂志, 2019, 33(2): 138-142.
12. 刘文, 程若川. 甲状腺乳头状癌中央区淋巴结转移的预测因素. 中国普外基础与临床杂志, 2018, 25(1): 99-103.
13. Amin MB, Greene FL, Edge SB, et al. The Eighth Edition AJCC Cancer Staging Manual: continuing to build a bridge from a population-based to a more " personalized” approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
14. 廖铭兴, 张迪天, 杨先荣. 乳头状甲状腺微小癌颈部中央组淋巴结的转移规律及影响因素分析. 中国医师进修杂志, 2014, 37(26): 51-53.
15. 边学海, 李世杰, 张广, 等. 甲状腺微小乳头状癌颈淋巴结转移影响因素的初步研究(附 1 180 例报道). 国际外科学杂志, 2013, 40(2): 105-108.
16. 高庆军, 王南鹏, 赵代伟. cN0 期甲状腺乳头状微小癌中央区淋巴结隐性转移危险因素. 中国普通外科杂志, 2015, 24(11): 1504-1510.
17. 刘文, 程若川, 苏艳军, 等. 2015 版美国甲状腺协会指南 cN0 甲状腺乳头状癌手术方案合理性分析. 中国实用外科杂志, 2017, 37(5): 568-571, 576.
18. Kim KE, Kim EK, Yoon JH, et al. Preoperative prediction of central lymph node metastasis in thyroid papillary microcarcinoma using clinicopathologic and sonographic features. World J Surg, 2013, 37(2): 385-391.
19. 吴红伟, 沈丰, 孙少华, 等. 全甲状腺切除+预防性中央区淋巴结清扫术治疗多灶性甲状腺乳头状癌 103 例临床分析. 中国普外基础与临床杂志, 2016, 23(3): 324-327.
20. 王伟斌, 苏星韵, 阮佳莹, 等. 2 682 例甲状腺乳头状癌临床病理及预后分析. 中华普通外科杂志, 2018, 33(5): 393-397.
21. 吴昕, 徐协群, 郑朝纪, 等. 分化型甲状腺癌再次手术的临床分析. 中国普外基础与临床杂志, 2017, 24(7): 813-818.
22. 王彬, 郭泰. 甲状腺乳头状癌颈侧区淋巴结转移相关影响因素分析. 山西医科大学学报, 2019, 50(2): 202-205.
23. 张润方, 张松涛, 龚文博, 等. cN0 期甲状腺乳头状癌侧颈淋巴结转移影响因素. 中华内分泌外科杂志, 2017, 12(6): 509-512.
24. Zeng RC, Zhang W, Gao EL, et al. Number of central lymph node metastasis for predicting lateral lymph node metastasis in papillary thyroid microcarcinoma. Head Neck, 2014, 36(1): 101-106.
25. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid, 2016, 26(1): 1-133.
26. Lee YS, Lim YS, Lee JC, et al. Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma: preliminary report. World J Surg, 2010, 34(11): 2558-2563.
27. Hu D, Zhou J, He W, et al. Risk factors of lateral lymph node metastasis in cN0 papillary thyroid carcinoma. World J Surg Oncol, 2018, 16(1): 30.
28. 薛文丹, 邢孔丽, 李小清. 超声检查对甲状腺乳头状癌早期颈部淋巴结转移的诊断价值分析. 检验医学与临床, 2018, 15(6): 754-756, 760.
29. 张宏春, 耿喆. 高频超声联合 FNAC 对甲状腺乳头状癌颈部淋巴结转移的诊断价值. 实用癌症杂志, 2018, 33(11): 1869-1872.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Explore the sweeping strategy of cervical lymph node metastasis in papillary thyroid carcinoma once again

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