The relationship between the number of dissected central lymph nodes and clinical outcome in pN<sub>1a</sub>papillary thyroid carcinoma

赵　腾; 高　文; 梁　军

doi:10.19401/j.cnki.1007-3639.2017.04.003

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The relationship between the number of dissected central lymph nodes and clinical outcome in pN_1apapillary thyroid carcinoma

更新时间：2025-12-31

- The relationship between the number of dissected central lymph nodes and clinical outcome in pN_1apapillary thyroid carcinoma
- China Oncology Vol. 27, Issue 4, Pages: 256-261(2017)
- 作者机构：
  
  1. 中国医学科学院，北京协和医学院，北京协和医院核医学科,北京,100730
  2. 首都医科大学附属北京世纪坛医院耳鼻咽喉头颈外科,北京,100038
  3. 青岛大学附属医院肿瘤科,山东,青岛,266003
  4. 北京大学肿瘤医院肿瘤内科,北京,100142
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2017.04.003
  CLC：
- Published Online：05 May 2017，
  
  Published：05 May 2017
- 稿件说明：
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赵　腾,高　文,梁　军,等. pN

赵　腾, 高　文, 梁　军. The relationship between the number of dissected central lymph nodes and clinical outcome in pN_1apapillary thyroid carcinoma[J]. China Oncology, 2017, 27(4): 256-261.
赵　腾,高　文,梁　军,等. pN DOI： 10.19401/j.cnki.1007-3639.2017.04.003.

赵　腾, 高　文, 梁　军. The relationship between the number of dissected central lymph nodes and clinical outcome in pN_1apapillary thyroid carcinoma[J]. China Oncology, 2017, 27(4): 256-261. DOI： 10.19401/j.cnki.1007-3639.2017.04.003.

摘要

背景与目的：甲状腺乳头状癌(papillary thyroid carcinoma，PTC)常发生颈部淋巴结转移，多见于颈部中央区。该研究旨在探讨转移淋巴结数小于等于5枚的pN

PTC患者颈部中央区淋巴结清扫数与

131

I“清甲”治疗后临床转归的关系。方法：回顾性分析2012年2月—2014年12月北京协和医院收治的167例经术后病理证实存在1～5枚淋巴结转移的pN

PTC患者的临床资料，均行全甲状腺切除或近全甲状腺切除联合中央区淋巴结清扫术。经过

131

I“清甲”治疗后中位随访26个月，将患者的临床转归根据美国甲状腺协会(American Thyroid Association，ATA)2015年发布的《成人甲状腺结节与分化型甲状腺癌诊治指南》分为：满意(excellent response， ER)、不确切(indeterminate response，IDR)、血清学反应欠佳(biochemical incomplete response，BIR)和影像学反应欠佳(structural incomplete response，SIR)。计算不同淋巴结清扫数对应的累计ER率(以ER

表示，n为淋巴结清扫数，ER

为清扫数小于等于n枚淋巴结后达到ER的患者数占清扫数小于等于n枚淋巴结的总人数的百分比)，分析中央区淋巴结清扫数与ER

的关系。结果：随着中央区淋巴结清扫数增多，ER

总体呈上升趋势，ER

、ER

和ER

分别为25.0%、66.7%、74.7%和79.1%，且n由1至10时ER

升高明显。n大于等于10的患者的满意率高于n小于10的患者，差异有统计学意义(85.7% vs 73.3%，P=0.05)。多因素Logistic回归分析显示，中央区淋巴结清扫数大于等于10枚(OR=2.720，95%CI：1.052~7.033，P=0.039)、

131

I治疗前刺激性甲状腺球蛋白(stimulated thyroglobulin，sTg)水平(OR=0.955，95%CI：0.926~0.984，P=0.003)是影响ER的独立预后因素。结论：随着中央区淋巴结清扫数的增多，pN

PTC患者

131

I“清甲”治疗后更易达到ER；对于淋巴结转移数小于等于5枚的pN

PTC患者，中央区淋巴结清扫数大于等于10枚有助于其

131

I“清甲”治疗后达到ER。

Abstract

Background and purpose: Neck lymph node metastasis

most of which presents in central neck compartment

is common in patients with papillary thyroid carcinoma (PTC). The objective of this study was to investigate the relationship between the number of dissected central neck lymph nodes and clinical outcome after radioactive iodine (RAI) ablation in pN1a PTC with no more than 5 lymph nodes involvement. Methods: A total of 167 PTC patients who had 1-5 proven metastatic lymph nodes according to postoperative pathological diagnosis were retrospectively analyzed

all of whom underwent total or near total thyroidectomy and central lymph node dissection. After a median follow-up period of 26 months

the clinical outcome of each patient was evaluated as excellent response (ER)

indeterminate response (IDR)

biochemical incomplete response (BIR)

or structural incomplete response (SIR) according to the new American Thyroid Association guidelines. The accumulative ER rate (ER

) was calculated in patients with different numbers of dissected lymph nodes (ER

was defined as the proportion of patients who achieved ER with the dissected lymph node number of ≤n). The relationship between the number of dissected central neck lymph nodes and ER

were investigated. Results: As the increase in the number of dissected central neck lymph nodes，there was also an overall increase in ER

especially when n rose from 1 to 10. The values of ER

and ER

were 25.0%

66.7%

74.7% and 79.1%

respectively. Besides

the proportion of patients who achieved ER was higher in those with 10 or more dissected lymph nodes than in those with less than 10 (85.7% vs 73.3%

P=0.05). In the multivariate logistic regression analysis

both the dissected central lymph node number of ≥10 (OR=2.720

95%CI: 1.052-7.033

P=0.039) and the level of preablation stimulated thyroglobulin (OR=0.955

95%CI: 0.926-0.984

P=0.003)

were shown to contribute independently to ER. Conclusion: As the increasing number of dissected central neck lymph nodes

the percentage of pN

PTC patients that achieved ER after RAI ablation generally rises. In pN

PTC patients with no more than 5 lymph nodes involvement

a central compartment dissection with 10 or more lymph nodes might help them achieve ER after RAI ablation.

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The relationship between the number of dissected central lymph nodes and clinical outcome in pN1apapillary thyroid carcinoma

DOI：10.19401/j.cnki.1007-3639.2017.04.003

摘要

Abstract

关键词

Keywords

references

The relationship between the number of dissected central lymph nodes and clinical outcome in pN_1apapillary thyroid carcinoma