山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (3): 120-124.doi: 10.6040/j.issn.1673-3770.1.2020.034

• 临床研究 • 上一篇    

甲状腺乳头状癌前上纵隔淋巴结转移临床病理特征初步分析

宁玉东, 蔡永聪, 孙荣昊, 姜健, 周雨秋, 税春燕, 汪旭, 郑王虎, 何天琪, 李超   

  1. 电子科技大学医学院附属肿瘤医院/四川省肿瘤研究所/四川省癌症防治中心/四川省肿瘤医院 头颈外科, 四川 成都 610041
  • 发布日期:2020-06-29
  • 通讯作者: 李超. E-mail: headneck@qq.com
  • 基金资助:
    四川省卫健委适宜技术推广项目-甲状腺结节规范化诊治技术项目推广(18SYJS07)

Preliminary analysis of the anterior superior mediastinal lymph node metastasis in thyroid papillary carcinoma

NING Yudong, CAI Yongcong, SUN Ronghao, JIANG Jian, ZHOU Yuqiu, SHUI Chunyan, WANG Xu, ZHENG Wanghu,   

  1. HE Tianqi, LI ChaoDepartment of Head and Neck surgery, Cancer Hospital Affiliate to School of Medicine, University of Electronic and Technology of China / Sichuan Institute of Cancer Research / Sichuan Cancer Prevention and Control Center / Sichuan Cancer Hospital, Chengdu 610041, Sichuan, China
  • Published:2020-06-29

摘要: 目的 探讨肿瘤位置、最大直径及甲状腺外浸等临床病理特征与甲状腺癌前上纵隔淋巴结转移的关系。 方法 研究分析初次手术治疗的60例甲状腺乳头状癌患者临床及病理资料,运用检验临床病理特征与前上纵隔淋巴结阳性率的相关性。 结果 肿块位置、最大直径、数量、腺体外侵、受累腺叶数及Ⅵ区淋巴结转移等特征,以及患者年龄等相关因素中,只有VI区淋巴结对前上纵隔淋巴结状态有影响;60例患者前上纵隔淋巴结转移率为10/60(16.67%)。相关因素的前上纵隔淋巴结转移率对比:≥55岁vs <55岁(20% vs 16.36%, P<0.05);肿块位于下极 vs 上极 vs 中极(P>0.05);最大直径≥1.5 cm vs 最大直径<1.5 cm(18.18% vs 15.79, P>0.05);单灶 vs 多灶(21.88% vs 10.71%, P>0.05);单叶 vs 多叶(17.5% vs 15%, P>0.05);男性vs女性(20% vs 15.55%, P>0.05); Ⅵ区淋巴结阳性vs 阴性(24.43% vs 3.57%, P<0.05); 结论 总体来说,甲状腺乳头状癌前上纵隔淋巴结转移率较低。本研究发现VI区淋巴结状态可能与前上纵隔淋巴结转移相关,未来仍需大样本前瞻性的研究验证。

关键词: 甲状腺乳头状癌, 颈部淋巴结转移, 前上纵隔淋巴结, 中央区淋巴结, 肿瘤

Abstract: Objective To investigate the relationship between clinicopathological features such as the tumor location, maximum diameter, extranodal thyroid invasion, and anterior superior mediastinal lymph node metastasis of thyroid carcinoma. Methods We analyzed the clinical and pathological data of 60 patients with thyroid papillary carcinoma who were admitted to the Head and Neck Surgery Department at Sichuan Cancer Hospital for primary surgery between September 2018 and February 2019. The correlation between the clinical and pathological features and the positive rate of the anterior and upper mediastinal lymph nodes was analyzed using the chi-square test. Results Among the features of tumor location, maximum diameter, number, extranodal invasion, number of involved gland lobes and lymph node metastasis in region Ⅵ, as well as the age of patients and other relevant factors, only the lymph nodes in region Ⅵ affected the status of anterior superior mediastinal lymph nodes. Ten of the 60 patients(16.67%)had anterior superior mediastinal lymph node metastasis. The rates of anterior superior mediastinal lymph node metastasis were compared among the related factors: age > or equal to 55 years vs. younger than 55 years(20% vs. 16.36%; P<0.05); mass located in the lower pole vs. the upper pole vs. the middle pole(P>0.05); maximum diameter greater than or equal to 1.5 cm vs. less than 1.5 cm(18.18% vs. 15.79; p >0.05), single focus vs. multiple focus(21.88% vs. 10.71%; P>0.05), single vs. multiple leaves(17.5% vs. 15%; P>0.05); males vs. females(20% vs. 15.55%; P>0.05); positive vs. negative lymph nodes in area Ⅵ(24.43% vs. 3.57%; P<0.05). Conclusion The rate of anterior and upper mediastinal lymph node metastasis in thyroid papillary carcinoma is relatively low. In this study, it was found that the status of lymph nodes in Ⅵ region may be related to anterior superior mediastinal lymph node metastasis, and prospective studies with large samples are still needed in the future.

Key words: Papillary carcinoma of thyroid, Cervical lymph node metastasis, Anterior superior mediastinal lymph nodes, Lymph nodes in central region, Tumor

中图分类号: 

  • R736
[1] 马宁, 李进让, 郭红光. cN0甲状腺乳头状癌患者Ⅵ区淋巴结转移的危险因素分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(8): 641-644. doi:10.13201/j.issn.1001-1781.2016.08.015. MA Ning, LI Jinrang, GUO Hongguang. Risk factors of level Ⅵ lymph node metastasis in cN0 papillary thyroid carcinoma[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(8): 641-644. doi:10.13201/j.issn.1001-1781.2016.08.015.
[2] 丁金旺, 彭友, 张卧, 等. 单侧甲状腺乳头状癌对侧中央区淋巴结转移的临床危险因素分析[J]. 中国耳鼻咽喉头颈外科, 2018, 25(8): 406-410. doi:10.16066/j.1672-7002.2018.08.002. DING Jinwang, PENG You, ZHANG Wo, et al. Clinical risk factors for contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2018, 25(8): 406-410. doi:10.16066/j.1672-7002.2018.08.002.
[3] Tam S, Boonsripitayanon M, Amit M, et al. Survival in differentiated thyroid cancer: comparing the AJCC cancer staging 7th and 8th editions[J]. Thyroid, 2018,28(10):1301-1310. doi: 10.1089/thy.2017.0572.
[4] 鄢丹桂, 张彬. 甲状腺乳头状癌临床N0患者颈部淋巴结处理[J]. 中华耳鼻咽喉头颈外科杂志, 2012, 47(3): 257-260. doi: 10.3760/cma.j.issn.1673-0860.2012.03.022.
[5] 高晓倩, 姜震, 耿琛琛, 等. 术前超声评估分化型甲状腺癌颈部淋巴结转移[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 135-139. doi: 10.6040/j.issn.1673-3770.0.2018.443. GAO Xiaoqian, JIANG Zhen, GENG Chenchen, et al. Preoperative ultrasonography in detecting cervical lymph node metastasis in differentiated thyroid cancer[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(1): 135-139. doi: 10.6040/j.issn.1673-3770.0.2018.443.
[6] American Thyroid Association Surgery Working Group, American Association of Endocrine Surgeons,, American Academy of Otolaryngology-Head and Neck Surgery, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer[J]. Thyroid, 2009, 19(11): 1153-1158. doi:10.1089/thy.2009.0159.
[7] Dralle H, Musholt TJ, Schabram J, et al. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors[J]. Langenbecks Arch Surg, 2013, 398(3): 347-375. doi:10.1007/s00423-013-1057-6.
[8] Hasegawa Y, Saikawa M. Update on the classification and nomenclature system for neck dissection: revisions proposed by the Japan Neck Dissection Study Group[J]. Int J Clin Oncol, 2010, 15(1): 5-12. doi:10.1007/s10147-009-0019-z.
[9] 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[J].中华内分泌代谢杂志,2012, 28(10): 779-797. doi:10.3760/cmaj.issn.1000-6699:2012.10.002.
[10] 中华耳鼻咽喉头颈外科杂志编辑委员会头颈外科组,中华医学会耳鼻咽喉头颈外科学分会头颈外科学组,中国医师协会耳鼻喉分会头颈外科学组. 头颈部鳞状细胞癌颈淋巴结转移处理的专家共识[J]. 中华耳鼻咽喉头颈外科杂志,2016,51(1):25-33. doi: 10.3760/cma.j.issn.1673-0860.2016.01.005.
[11] 汪菁, 王圣应. 中央区的界定及细化在甲状腺癌治疗中的意义[J]. 中华耳鼻咽喉头颈外科杂志, 2018, 53(4): 312-316. doi: 10.3760/cma.j.issn.1673-0860.2018.04.016. WANG Jing, WANG Shengying, Significance of the definition and detailing of the central neck compartment in the treatment of thyroid carcinoma[J]. Chinese JOurnal of Otorhinolaryngology Head and Neck Surgery, 2018, 53(4): 312-316. doi: 10.3760/cma.j.issn.1673-0860.2018.04.016.
[12] 章文杰. 预防性颈中央区淋巴结清扫术与传统甲状腺全切除术治疗甲状腺癌的效果对比[J]. 中国当代医药, 2018, 25(14): 79-81. doi: CNKI:SUN:ZGUD.0.2018-14-024. ZHANG Wenjie. Comparison of preventive cervical lymph node dissection and conventional total thyroidectomy for thyroid cancer[J]. China Modern Medicine, 2018, 25(14): 79-81. doi: CNKI:SUN:ZGUD.0.2018-14-024.
[13] 潘先均, 胡代星, 苏新良. 颈部中央区淋巴结清扫及术中冰冻病理检查在甲状腺微小乳头状癌治疗中的临床价值[J]. 上海交通大学学报(医学版), 2018, 38(2): 180-183. doi: CNKI:SUN:SHEY.0.2018-02-016. PAN Xianjun, HU Daixing, SU Xinliang. Clinical value of central lymph node dissection and intraoperative frozen-section examination in the treatment of papillary thyroid microcarcinoma[J]. Journal of Shanghai Jiao Tong University(Medical Science), 2018, 38(2): 180-183. doi: CNKI:SUN:SHEY.0.2018-02-016.
[14] 卞雪艳,孙姗姗,郭文宇, 等. 甲状腺微小乳头状癌颈淋巴结转移的危险因素分析[J]. 中国肿瘤临床, 2015, 42(13): 658-662. doi: CNKI:SUN:ZGZL.0.2015-13-007. BIAN Xueyan, SUN Shanshan, GUO Wenyu, et al. Risk factor analysis for cervical nodal metastasis in papillary microcarcinoma[J]. Chinese Journal of Clinical Oncology, 2015, 42(13): 658-662. doi: CNKI:SUN:ZGZL.0.2015-13-007.
[15] 彭琛, 魏松锋, 郑向前, 等. 1 401例甲状腺微小乳头状癌临床病理特征及中央区淋巴结转移危险因素分析[J]. 中国肿瘤临床, 2016, 43(3): 95-99. doi: CNKI:SUN:ZGZL.0.2016-03-002. PENG Chen, WEI Songfeng, ZHENG Xiangqian, et al. Clinicopathological features and risk factors for central compartment nodal metastasis in papillary thyroid microcarcinoma: a study of 1 401 patients[J]. Chinese Journal of Clinical Oncology, 2016, 43(3): 95-99. doi: CNKI:SUN:ZGZL.0.2016-03-002.
[16] Wang LY, Versnick MA, Gill AJ, et al. Level VII is an important component of central neck dissection for papillary thyroid cancer. Ann Surg Oncol 2013,20(7):2261-2265.
[17] Choi JY, Choi YS, Park YH, et al. Experience and analysis of level VII cervical lymph node metastases in patients with papillary thyroid carcinoma[J]. J Korean Surg Soc, 2011, 80(5): 307. doi:10.4174/jkss.2011.80.5.307.
[18] Fayek IS, Kamel AA, Sidhom NF. Safety and prognostic impact of prophylactic level VII lymph node dissection for papillary thyroid carcinoma[J]. Asian Pac J Cancer Prev, 2015, 16(18): 8425-8430. doi:10.7314/apjcp.2015.16.18.8425.
[19] Gonçalves Filho J, Zafereo ME, Ahmad FI, Nixon IJ, et al. Decision Making for the Central Compartment in Differentiated Thyroid Cancer, European Journal of Surgical Oncology(2018). doi:10.1016/j.ejso.2018.08.005.
[20] 李正江, 苗绪学, 唐平章, 等. 甲状腺癌纵隔淋巴结转移的外科处理[J]. 中华肿瘤杂志, 2006, 28(2): 145-147. doi:10.3760/j.issn:0253-3766.2006.02.019. LI Zhengjiang, MIAO Xuxue, TANG Pingzhang, et al. Surgical management of upper mediastinal lymph nodes metastases from thyroid carcinoma[J]. Chinese Journal of Oncology, 2006, 28(2): 145-147. doi:10.3760/j.issn:0253-3766.2006.02.019.
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