甲状腺微小癌位置与颈淋巴结转移的关系
The Correlation between the Location of Thyroid Papillary Microcarcinoma and Cervical Lymph Node Metastasis
-
摘要: 目的 探寻甲状腺乳头状微小癌病灶位置与颈淋巴结转移的关系.方法 回顾分析云南省肿瘤医院头颈外科2013年1月至2016年1月收治334例甲状腺乳头状微小癌患者的临床资料, 研究病灶位置、病灶大小、是否突破被膜等因素与颈部中央区淋巴结及颈侧区淋巴结转移的关系.结果 甲状腺乳头状微小癌位于甲状腺上极时发生VI区淋巴结转移率为33.33% (26/104) , 中极为39.81% (43/108) , 下极为52.46% (64/122) , 肿瘤位于下极时更倾向于发生VI区淋巴结转移 (P<0.05) .发生颈侧区淋巴结转移者为46例 (46/334, 13.77%) , 上极肿瘤发生颈侧区淋巴结转移率为21.15% (22/104) , 中极为11.11% (12/108) , 下极为9.83% (12/122) , 病灶位于甲状腺上级时更倾向于发生颈侧区淋巴结转移 (P=0.030) , 其中3例 (6.5%) 患者无中央区淋巴结转移而直接发生跳跃式颈侧区淋巴结转移。颈侧区淋巴结转移的患者中发生肿瘤突破被膜的比率为30.43% (14/46) , 高于未发生淋巴结转移的患者人群的19.09% (55/288) (P<0.05) .结论 甲状腺乳头状微小癌病灶位置与颈部淋巴结转移存在一定的相关性.Abstract: Objective To investigate the relationship between the location of thyroid papillary microcarcinoma and cervical lymph node metastasis. Me thods The clinical data of 334 cases of thyroid papillary microcarcinoma were retrospectively analyzed. The location of the lesion, the size of the lesion, the situation of the capsule and other factors were compared in patients with central lymph nodes or/and cervical lymph node metastasis.Re s ults The lymph node metastasis rate were 33.33% (26/104) , 39.81% (43/108) , and 52.46% (64/122) , when the papillary thyroid microcarcinoma was located at the upper pole, median pole, and lower pole respectively (P<0.005) . There were 46 cases (46/334, 13.77%) with cervical lymph node metastasis. The metastasis rate of cervical lymph node were 21.15% (22/104) , 11.11% (12/108) , and 9.83% (12/122) , when the papillary thyroid microcarcinoma was located at the upper pole, median pole, and lower pole respectively (P = 0.003) . 3 patients (6.5%) had no central lymph node metastasis and direct skipping of the cervical lymph nod trensfer. The rate of tumor break through through the membrane in patients with cervical lymph node metastases was 30.43% (14/46) , which was higher than the 19.09% (55/288) of patients without lymph node metastasis (P <0.005) .Conclus ions There is a certain correlation between the location of papillary thyroid microcarcinoma and cervical lymph node metastasis.
-
[1] [1]WITT R L.What is the best treatment of incidental papillary thyroid microcarcinoma Laryngoscope 2016;126:2203-2204[J].Jemal A, Murray T, Samuels A, et al.Cancer statistics, 2003.CA Cancer J Clin, 2003, 53 (10) :5-26. [2] [2] LUNDGREN C I, HALL P, DICKMAN P W, et al.Clinically significant prognostic factors for differentiated thyroid carcinoma:a population-based, nested case-control study[J].Cancer, 2006, 106 (3) :524-531. [3] [3]GLOVER A R, GUNDARA J S, NORL N O, et al.The pros and cons of prophylactic central neck disection in papilary thyroid carcinoma[J].Gland Surg, 2013, 2 (4) :196-205. [4] [4]COOPER D S, DOHERTY G M, HAUGEN B R, et al.Revised American Thyroid Asociation management guidelines for patients with thyroid nodules and diferentiated thyroid cancer[J].Thyroid, 2009, 19 (11) 11:1167-1214. [5] [5]HAUGEN B R M, ALEXANDER E K, BIBLE K C, et al.2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer[J].Thyroid, 2015, 123 (3) :372-381. [6] [6]WADA N, DUH QY, SUGINO K, et al.Lymph node metastasis from 259 papillary thyroid microcarcinomas:frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection[J].Ann Surg, 2003, 273 (3) :399-407. [7]中国抗癌协会头颈肿瘤专业委员会.分化型甲状腺癌诊治指南[J].中国实用外科杂志, 2011, 31 (10) :908-914. [8] [8]LEE Y S, LIM Y S, LEE J C, et al.Clinical implication of the number of central lymph node metastasis in papillary thyroid carcinoma:preliminary report[J].World J Surg, 2010, 34 (11) :2558-2563. [9] [9]KIM E, PARK J S, SON K R, et al.Preoperative diagnosis of cervical metastatic lymph nodes in papillary thyroid carcinoma:comparison of ultrasound, computed tomography, and combined ultrasound with computed tomography[J].Thyroid, 2008, 18 (4) :411-418. [10] [10]EUN Y G, LE Y C, KWON K H.Predictive factors of contralateral paratracheal lymph node metastasis in papilary thyroid cancer:prospective multicenter study[J].Otolaryngol Head Neck Surg, 2014, 150 (2) :210-215. [11] [11]KUPFERMAN M E, PATTERSON M, MANDEL SJ, et al.Patterns of lateral neck metastasis in papillary thyroid carcinoma[J].Arch Otolaryngol Head Neck Surg, 2004, 130 (7) :857-860. [12] [12]LUNDGREN C I, HALL P, DICKMAN P W, et al.Clinically significant prognostic factors for differentiated thyroid carcinoma:a population-based, nested case-control study[J].Cancer, 2006, 3 (3) :524-531. [13] [13]LE K E, CHUNG I Y, KANG E, et al.Ipsilateral and contralateral central lymph node metastasis in papilary thyroid cancer:paterns and predictive factors of nodal metastasis[J].Head Neck, 2013, 35 (5) :672-676. [14] [14]MACHENS A, HOLZHAUSEN H J, DRALLE H.Skip metastases in thyroid cancer leaping the central lymph node compartment[J].Arch Surg, 2004, 139 (1) :43-45. [15] [15]DUCCI M, APPETECCHIA M, MARZETTI M.Neck dissection for surgical treatment of lymphnode metastasis in papillary thyroid carcinoma[J].J Exp Clin Cancer Res, 1997, 6 (3) :333-335. [16] [16]KOO B S, LIM H S, LIM Y C, et al.Occult contralateral carcinoma in patients with unilateral papillary thyroid microcarcinoma[J].Ann Surg Oncol, 2010, 7 (4) :1101-1105. [17] [17]LEE B J, WANG S G, LEE J C, et al.Level IIb lymph node metastasis in neck dissection for papillary thyroid carcinoma[J].Arch Otolaryngol Head Neck Surg, 2007, 133 (10) :1028-30. [18] [18]LEE Y S, SHIN S C, LIM Y S, et al.Tumor location-dependent skip lateral cervical lymph node metastasis in papillary thyroid cancer[J].Head Neck, 2014, 36 (6) :887-891. [19] [19]KONTUREK A, BARCZYNSKI M, NOWAK W, et al.Risk of lymph node metastases in multifocal papilary thyroid cancer asociated with Hashimoto’s thyroiditis[J].Langenbecks Arch Surg, 2014, 399 (2) :229-236. [20] [20]CAI Y F, WANG Q X, NI C, et al.The clinical relevance of psammoma body and hashimoto thyroiditis in papillary thyroid carcinoma:a large case-control study[J].Medicine, 2015, 94 (44) :1-8.
点击查看大图
计量
- 文章访问数: 2581
- HTML全文浏览量: 920
- PDF下载量: 82
- 被引次数: 0