Relationship between subgroups of central and lateral lymph node metastasis in clinically node-negative papillary thyroid carcinoma

作者全名："Zhou, Jing; Li, Da-Xue; Gao, Han; Su, Xin-Liang"

作者地址："[Zhou, Jing; Li, Da-Xue; Gao, Han] Chongqing Hlth Ctr Women & Children, Dept Thyroid & Breast Surg, Chongqing 401120, Peoples R China; [Su, Xin-Liang] Chongqing Med Univ, Dept Thyroid & Breast Surg, Affiliated Hosp 1, Chongqing 400016, Peoples R China; [Su, Xin-Liang] Chongqing Med Univ, Dept Thyroid & Breast Surg, Affiliated Hosp 1, 1 Youyi Rd, Chongqing 400016, Peoples R China"

通信作者："Su, XL (通讯作者)，Chongqing Med Univ, Dept Thyroid & Breast Surg, Affiliated Hosp 1, 1 Youyi Rd, Chongqing 400016, Peoples R China."

来源：WORLD JOURNAL OF CLINICAL CASES

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000797318400007

JCR分区：Q3

影响因子：1.1

年份：2022

卷号：10

期号：12

开始页：3709

结束页：3719

文献类型：Article

关键词：Papillary thyroid carcinoma; Lymph node metastasis; Clinically node-negative; Prophylactic lymph node dissection; Prelaryngeal

摘要："BACKGROUND & nbsp;Lymph node metastasis (LNM) of papillary thyroid carcinoma (PTC) has a certain regularity and occurs first to the central lymph node and then to the lateral lymph node. The pathway of PTC LNM can guide surgical prophylactic lymph node dissection (LND) for clinical surgeons.& nbsp;AIM & nbsp;To investigate the relationship between subgroups of central LNM and lateral LNM in unilateral clinically node-negative PTC (cN0-PTC).& nbsp;METHODS & nbsp;Data were collected for 1089 PTC patients who underwent surgical treatment at the Department of Endocrine and Breast Surgery of the First Hospital of Chongqing Medical University from January 2016 to December 2017. A total of 388 unilateral cN0-PTC patients met the inclusion criteria and were enrolled in this study. The clinical and pathological data for these 388 patients who underwent total thyroidectomy + central LND + lateral LND were retrospectively analyzed. The relationship between the central LNM and lateral LNM subgroups was investigated.& nbsp;RESULTS & nbsp;The coincidence rate of cN0-PTC was only 30.0%.Optimal scaling regression analysis showed that sex (57.1% vs 42.9%, P = 0.026), primary tumor size (68.8% vs 31.2%, P = 0.008), tumor location (59.7% vs 40.3%, P = 0.007), extrathyroid extension (ETE) (50.6% vs 49.9%, P = 0.046), and prelaryngeal LNM (57.1% vs 42.9%, P = 0.004) were significantly associated with ipsilateral level-II LNM. Their importance levels were 0.122, 0.213, 0.172, 0.110, and 0.227, respectively. Primary tumor size (74.6% vs 30.2%, P = 0.016), pretracheal LNM (67.5% vs 32.5%, P < 0.001), and paratracheal LNM (71.4% vs 28.6%, P < 0.001) were significantly associated with ipsilateral level-III LNM. Their importance levels were 0.120, 0.408, and 0.351, respectively. Primary tumor size (72.1% vs 27.9%, P = 0.003), ETE (70.4% vs 29.6%, P = 0.016), pretracheal LNM (68.3% vs 31.7%, P=0.001), and paratracheal LNM (80.8% vs 19.2%, P < 0.001) were significantly associated with ipsilateral level-IV LNM. Their importance levels were 0.164, 0.146, 0.216, and 0.472, respectively.& nbsp;CONCLUSION & nbsp;The LNM pathway of thyroid cancer has a certain regularity. For unilateral cN0-PTC patients with a tumor diameter > 2 cm and pretracheal or ipsilateral paratracheal LNM, LND at ipsilateral level III and level IV must be considered. When there is a tumor in the upper third of the thyroid with prelaryngeal LNM, LND at level II, level III and level IV must be considered."

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