Evaluation of the clinical and ultrasound characteristics in the metastasis of lymph node posterior to right recurrent laryngeal nerve in papillary thyroid carcinoma
-
摘要: 目的 评估甲状腺乳头状癌(PCT)患者右侧喉返神经后方淋巴结(lymph nodes posterior to right recurrent laryngeal nerve,LN-prRLN)转移的相关临床及超声特征危险因素。方法 选取2016年1月—2019年12月于徐州医科大学附属宿迁人民医院手术治疗的右叶或双叶PTC患者,共158例,收集临床资料进行回顾性分析。根据术后病理LN-prRLN转移情况,将上述患者分为转移组(n=34)和对照组(n=124)。比较2组临床和声像图特征,分析与LN-prRLN转移有关的危险因素。结果 本研究中PTC患者的LN-prRLN转移率为21.52%(34/158)。LN-prRLN转移组和对照组在年龄、肿瘤直径、包膜浸润、多灶性、喉前淋巴结及右侧喉返神经前方淋巴结(lymph nodes anterior to right recurrent laryngeal nerve,LN-arRLN)转移情况、超声显示肿瘤接触被膜方面比较差异均有统计学意义(P均＜0.05)。多因素Logistic回归分析显示:右侧肿瘤直径、包膜浸润、喉前淋巴结及LN-arRLN转移情况均与LN-prRLN转移显著相关(P均＜0.05)。ROC曲线显示预测LN-prRLN转移的右肿瘤直径的最佳截断值为12.7 mm,ROC曲线下面积(AUC)=0.72,灵敏度和特异度分别为74.3%和72.9%。 结论 PTC患者中,对于右侧叶肿瘤直径≥12.7 mm、包膜浸润、喉前淋巴结及LN-arRLN转移,应进行预防性LN-prRLN清扫。
-
关键词:
- 甲状腺乳头状癌 /
- 右侧喉返神经后方淋巴结 /
- 超声
Abstract: Objective To evaluate the risk factors of clinical and ultrasound characteristics in the metastasis of lymph node posterior to right recurrent laryngeal nerve (LN-prRLN) in papillary thyroid carcinoma (PCT). Methods A total of 158 PCT patients in the right lobe or double lobe who were operated in Suqian People's Hospital Affiliated to Xuzhou Medical University from January 2016 to December 2019 were enrolled and their clinical data were retrospectively analyzed. According to the presence of LN-prRLN in postoperative pathological examination, the patients were divided into two groups: a metastasis group (n=34) and a control group (n=124). Both groups were compared for clinical and ultrasound characteristics. Logistic multivariable regression analysis was used to evaluate the risk factors related to LN-prRLN metastasis. Results In the current study, the LN-prRLN metastasis rate in PCT patients was 21.52% (34/158). There were significant differences between the LN-prRLN metastasis group and the control group in age,tumor diameter, extracapsular invasion, multifocality, the metastasis of prelaryngeal lymph nodes and lymph nodes anterior to right recurrent laryngeal nerve (LN-arRLN), and ultrasound-determined tumor contact capsule (P< 0.05). Logistic multivariable regression analysis showed that tumor diameter in the right lobe, extracapsular invasion, the metastasis of prelaryngeal lymph nodes and LN-arRLN were significantly correlated with LN-prRLN metastasis (P< 0.05). The ROC curve showed that the optimal cut-off value of tumor diameter in the right lobe to predict the metastasis of LN-prRLN was 12.7 mm (AUC=0.72), with a sensitivity of 74.3%and a specificity of 72.9%. Conclusions Prophylactic lymph node dissection is suggested for PCT patients with a tumor diameter≥12.7 m min the right lobe, extracapsular invasion,the metastasis of prelaryngeal lymph nodes and LN-arRLN. -
-
[1] Yan B, Hou Y, Chen D, et al. Risk factors for contralateral central lymph node metastasis in unilateral cN0 papillary thyroid carcinoma: a meta-analysis [J]. Int J Surg, 2018, 59(11): 90-98.
[2] 崔科英, 何建苗, 邱啸臣, 等. 甲状腺乳头状癌规范化手术治疗的临床特点分析 [J]. 解放军医学杂志, 2019, 44(11): 964-967. [3] 徐骁诚, 丁金旺, 彭友, 等. 右喉返神经后方淋巴结清扫在甲状腺乳头状癌中的临床研究 [J]. 中国耳鼻咽喉头颈外科, 2018, 25(2): 61-65. [4] 陈易来, 詹维伟, 周伟. 超声评估甲状腺乳头状癌不同分区转移性淋巴结的价值 [J].中华医学超声杂志(电子版), 2019, 16(9): 647-652. [5] 张明博, 付帅, 周昀, 等. 预测甲状腺微小癌的多元回归公式 [J]. 中国医学科学院学报, 2014, 36(1): 79-85. [6] Teixeira G, Teixeira T, Gubert F, et al. The incidence of central neck micrometastatic disease in patients with papillary thyroid cancer staged preoperatively and intraoperatively as N0 [J]. Surgery,2011, 150(6):1161-1167.
[7] Liu LS, Liang J, Li JH, et al. The incidence and risk factors for central lymph node metastasis in cN0 papillary thyroid microcarcinoma: a meta-analysis [J]. Eur Arch Otorhinolaryngol, 2017, 274(3): 1327-1338.
[8] Zhang P, Zhang B, Bu J, et al. Risk factors and clinical indication of metastasis to lymph nodes posterior to right recurrent laryngeal nerve in papillary thyroid carcinoma: a single-center study in China [J]. Head Neck, 2014, 36(9): 1335-1342.
[9] 杨志芳,詹维伟,周建桥.超声对桥本甲状腺炎甲状腺微小乳头状癌的诊断价值[J].中华医学超声杂志(电子版),2014,11(10):840-844. [10] Li C, Xiang J, Wang Y. Risk factors for predicting lymph nodes posterior to right recurrent laryngeal nerve (LN-prRLN) metastasis in thyroid papillary carcinoma: a meta-analysis [J/OL]. Int J Endocrinol, 2019, 2019: 7064328.
[11] Hou J, Shan H, Zhang Y, et al. Risk factors of metastasis to the lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma [J]. Eur Arch Otorhinolaryngol, 2020, 277(3): 881-886.
-
期刊类型引用(3)
1. 赵圆圆，贺奇，纪飞虹，代权伟，邱新光. 甲状腺乳头状癌合并乳腺癌患者的临床病理特征分析. 江苏大学学报(医学版). 2022(06): 461-466 . 
百度学术
2. 董华亮. 甲状腺乳头状癌患者术后并发症的观察及治疗体会. 医药论坛杂志. 2022(21): 54-57 . 百度学术
3. 段飞，查官金，邹辉文. 分析右喉返神经后方淋巴结清扫在甲状腺乳头状癌中的临床应用. 江西医药. 2021(12): 2302-2303+2338 . 百度学术
其他类型引用(0)
计量
- 文章访问数: 2366
- HTML全文浏览量: 1
- PDF下载量: 1839
- 被引次数: 3
下载:
.png)
