Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2024, Vol. 38 ›› Issue (4): 62-69.doi: 10.6040/j.issn.1673-3770.0.2023.485

• Original Article • Previous Articles    

A clinical study of lymph node metastasis rate, risk factors and dissection strategy in the central and lateral cervical region of stage cN0 papillary thyroid microcarcinoma

ZHANG Lin, XIN Yunchao, SHANG Xiaoling, XIE Qi, LIU Yachao   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, The First Affiliated Hospital of Hebei North University, Zhangjiakou 075000, Hebei, China
  • Published:2024-07-09

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Abstract: Objective To investigate the lymph node metastasis rate, risk factors and dissection strategy in the central and lateral cervical region of lymph node negative(cN0 stage)papillary thyroid microcarcinoma(PTMC). Methods 300 patients with stage cN0 PTMC who underwent surgical treatment were selected as the study objects. General data of all patients were collected and their clinicopathological data were retrospectively analyzed. The related factors that may affect cN0 stage PTMC lymph node metastasis were analyzed by method of univariate and multivariate Logistic regression analysis. Results Among 300 patients with cN0 stage PTMC undergoing surgical treatment, 174 cases(58.00%)had no lymph node metastasis and 126 cases(42.00%)had lymph node metastasis. There were 118 cases(39.33%)of central lymph node metastasis, 42 cases(14.00%)of lateral lymph node metastasis, 34 cases(11.33%)of central with lateral lymph node metastasis, 8 cases(2.67%)with lymph node metastasis in lateral cervical region but not central region, i.e. skipping lymph node metastasis. For male, age <45 years, tumor diameter ≥0.5 cm, capsular invasion was independent risk factor for central lymph node metastasis of PTMC(P<0.05). For male, age <45 years, tumor diameter ≥0.5 cm, upper pole tumor, capsular invasion and central lymph node metastasis were independent risk factors for lymph node metastasis in the lateral cervical region of PTMC(P<0.05). Conclusion For male, age <45 years old, tumor diameter ≥0.5 cm, capsular invasion are all independent risk factors for central and lateral lymph node metastasis of PTMC. The independent risk factors for lateral lymph node metastasis also include upper pole tumor and central lymph node metastasis. In clinical practice, this can be used to determine the area of lymph node metastasis and adopt targeted dissection strategies to improve the prognosis in patients.

Key words: Papillary thyroid microcarcinoma, Stage cN0, Lymph node metastasis, Risk factor, Dissection strategy

CLC Number: 

  • R736.1
[1] Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3): 209-249. doi:10.3322/caac.21660
[2] 李静静, 武欣欣, 毛宁, 等. 基于CT影像组学诺模图术前预测甲状腺乳头状癌颈部中央区淋巴结转移的研究[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 51-59. doi:10.6040/j.issn.1673-3770.0.2020.490 LI Jingjing, WU Xinxin, MAO Ning, et al. CT-based radiomics nomogram for the preoperative prediction of central lymph node metastases of papillary thyroid carcinoma[J]. J Otolaryngol Ophthalmol Shandong Univ, 2021, 35(4): 51-59. doi:10.6040/j.issn.1673-3770.0.2020.490
[3] 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[J]. Thyroid, 2016, 26(1): 1-133. doi:10.1089/thy.2015.0020
[4] 薛峰, 姜雪. 临床淋巴结阴性甲状腺乳头状微小癌与非微小癌的超声特征对比研究[J]. 中国医师进修杂志, 2021, 44(9): 801-804. doi:10.3760/cma.j.cn115455-20200528-00672 XUE Feng, JIANG Xue. Comparative study on sonographic features of clinical lymph node negative papillary thyroid microcarcinoma and non-microcarcinoma[J]. Chinese Journal of Postgraduates of Medicine, 2021, 44(9): 801-804. doi:10.3760/cma.j.cn115455-20200528-00672
[5] 武元元, 王军, 毛爱红, 等. 甲状腺微小乳头状癌颈中央区淋巴结转移评分系统的初步建立[J]. 中国耳鼻咽喉头颈外科, 2021, 28(11): 661-663. doi:10.16066/j.1672-7002.2021.11.001 WU Yuanyuan, WANG Jun, MAO Aihong, et al. Preliminary establishment of a scoring system for predicting cervical central lymph node metastasis in papillary thyroid microcarcinoma[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2021, 28(11): 661-663. doi:10.16066/j.1672-7002.2021.11.001
[6] Kim BY, Choi N, Kim SW, et al. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma[J]. Eur Arch Otorhinolaryngol, 2020, 277(2): 569-576. doi:10.1007/s00405-019-05702-3
[7] 薛刚, 孙新民, 林旭, 等. KCNK5双孔钾通道蛋白在甲状腺乳头状癌中的表达及临床意义[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 64-69. doi:10.6040/j.issn.1673-3770.0.2021.004 XUE Gang, SUN Xinmin, LIN Xu, et al. Expression and clinical significance of the KCNK5 double-pore potassium channel protein in papillary thy-roid carcinoma[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 64-69. doi:10.6040/j.issn.1673-3770.0.2021.004
[8] 祝嘉, 秦晓茹, 郝玲玲, 等. 甲状腺微小乳头状癌预后影响因素与治疗进展[J]. 中国医药导刊, 2021, 23(12): 907-911. doi: 10.3969/j.issn.1009-0959.2021.12.007 ZHU Jia, QIN Xiaoru, HAO Lingling, et al. Prognostic factors and treatment progress of papillary thyroid microcarcinoma[J]. Chinese Journal of Medicinal Guide, 2021, 23(12): 907-911. doi: 10.3969/j.issn.1009-0959.2021.12.007
[9] 刘兰侠, 刘杜先. 甲状腺乳头状癌亚型的临床病理特点及术后复发的影响因素分析[J]. 药物生物技术, 2020, 27(5): 462-466. doi:10.19526/j.cnki.1005-8915.20200515 LIU Lanxia, LIU Duxian. Analysis on the clinicopathologic features of thyroid papillary carcinoma subtype and the influencing factors of postoperative recurrence[J]. Pharmaceutical Biotechnology, 2020, 27(5): 462-466. doi:10.19526/j.cnki.1005-8915.20200515
[10] Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2019, 30(12): 1856-1883. doi:10.1093/annonc/mdz400
[11] 王晨, 张国梁, 张守亮. 甲状腺微小乳头状癌颈部中央区淋巴结转移相关因素分析[J]. 中国现代普通外科进展, 2020, 23(10): 821-822. doi:10.3969/j.issn.1009-9905.2020.10.016 WANG Chen, ZHANG Guoliang, ZHANG Shouliang. Analysis of related factors of lymph node metastasis in central cervical region of papillary thyroid carcinoma[J]. Chinese Journal of Current Advances in General Surgery, 2020, 23(10): 821-822. doi:10.3969/j.issn.1009-9905.2020.10.016
[12] 张莉, 王燕红, 丰荣红. 超声定量技术联合血清微小RNA-599及半乳糖凝集素-3在甲状腺乳头状癌颈部淋巴结转移中的应用研究[J]. 中国医师进修杂志, 2022, 45(12): 1142-1146. doi:10.3760/cma.j.cn115455-20211113-01324 ZHANG Li, WANG Yanhong, FENG Ronghong. Application of ultrasound quantitative technique combined with serum microRNA-599 and galectin-3 in cervical lymph node metastasis of papillary thyroid carcinoma[J]. Chinese Journal of Postgraduates of Medicine, 2022, 45(12): 1142-1146. doi:10.3760/cma.j.cn115455-20211113-01324
[13] 王金秋, 张立, 章佳波, 等. 甲状腺乳头状微小癌cN0期中央区淋巴结转移相关因素分析[J]. 中华内分泌外科杂志, 2020, 14(4): 279-283. doi:10.3760/cma.j.issn.115807-20191103-00213 WANG Jinqiu, ZHANG Li, ZHANG Jiabo, et al. Related risk factors of central lymph node metastasis in papillary thyroid microcarcinoma of CN0 stage[J]. Chinese Journal of Endocrine Surgery, 2020, 14(4): 279-283. doi:10.3760/cma.j.issn.115807-20191103-00213
[14] 陈皖肖, 倪忠鹏, 崔怀信. cN0期甲状腺乳头状癌中央区淋巴结转移的危险因素分析[J]. 中国普外基础与临床杂志, 2021, 28(4): 488-492. doi:10.7507/1007-9424.202006084 CHEN Wanxiao, NI Zhongpeng, CUI Huaixin. Analysis of risk factors for central lymph node metastasis in CN0 papillary thyroid carcinoma[J]. Chinese Journal of Bases and Clinics in General Surgery, 2021, 28(4): 488-492. doi:10.7507/1007-9424.202006084
[15] 陆一丹, 时开元, 欧笛, 等. 甲状腺微小癌预后风险评估与治疗决策的研究进展[J]. 中国肿瘤, 2020, 29(12): 962-969. doi:10.11735/j.issn.1004-0242.2020.12.A013 LU Yidan, SHI Kaiyuan, OU Di, et al. Progress on prognostic risk assessment and treatment strategy for thyroid microcarcinoma[J]. China Cancer, 2020, 29(12): 962-969. doi:10.11735/j.issn.1004-0242.2020.12.A013
[16] Chen ZD, Ruan JY, Yao YJ, et al. A comparison of the seventh and eighth editions of the AJCC staging systems to predict recurrence in papillary thyroid microcarcinoma[J]. Ann Surg Oncol, 2021, 28(11): 6564-6571. doi:10.1245/s10434-021-09596-6
[17] Song JL, Yan T, Qiu WW, et al. Clinical analysis of risk factors for cervical lymph node metastasis in papillary thyroid microcarcinoma: a retrospective study of 3686 patients[J]. Cancer Manag Res, 2020, 12: 2523-2530. doi:10.2147/CMAR.S250163
[18] Park JP, Roh JL, Lee JH, et al. Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma[J]. Am J Surg, 2014, 208(3): 412-418. doi:10.1016/j.amjsurg.2013.10.032
[19] Back K, Kim JS, Kim JH, et al. Superior located papillary thyroid microcarcinoma is a risk factor for lateral lymph node metastasis[J]. Ann Surg Oncol, 2019, 26(12): 3992-4001. doi:10.1245/s10434-019-07587-2
[20] 黄春, 邓畅, 苏新良. cN0甲状腺微小乳头状癌淋巴结转移的危险因素分析[J]. 中国普外基础与临床杂志, 2021, 28(7): 888-891. doi:10.7507/1007-9424.202009040 HUANG Chun, DENG Chang, SU Xinliang. Risk factors of lymph node metastasis in papillary thyroid microcarcinoma with CN0[J]. Chinese Journal of Bases and Clinics in General Surgery, 2021, 28(7): 888-891. doi:10.7507/1007-9424.202009040
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