CAJ | 학술논문

目的：探讨淋巴结临床阴性（ cN0）甲状腺乳头状癌选择性中央区淋巴结清扫的远期效果及其颈部淋巴结的处理方法。方法分析2000年1月至2006年12月行选择性中央区淋巴结清扫的136例初治颈部cN0甲状腺乳头状癌患者的临床病理特征、手术方式及预后。结果中央区淋巴结隐匿性转移率为61．0％。阳性淋巴结数1～13枚，平均2．47枚，其中＜3枚54例，≥3枚29例。多因素分析显示，年龄和被膜外侵犯为中央区淋巴结转移的独立影响因素（均P＜0．05）。全组患者的10年生存率为98．4％，10年颈侧区淋巴结累积复发转移率为23．4％。多因素分析显示，被膜外侵犯、中央区阳性淋巴结数为颈侧区淋巴结复发的独立影响因素（均P＜0．05）。颈侧区淋巴结复发转移的主要部位依次为Ⅳ区（14例，82．4％）、Ⅲ区（11例，64．7％）、Ⅱ区（5例，29．4％）和Ⅴ区（2例，11．8％）。结论 cN0甲状腺乳头状癌应常规行至少一侧中央区淋巴结清扫。应重视对cN0甲状腺乳头状癌颈侧区的处理，尤其是甲状腺被膜外侵犯或中央区转移淋巴结数≥3枚时。Ⅲ、Ⅳ区应为选择性颈侧区清扫的主要区域。
목적：탐토림파결림상음성（ cN0）갑상선유두상암선택성중앙구림파결청소적원기효과급기경부림파결적처리방법。방법분석2000년1월지2006년12월행선택성중앙구림파결청소적136례초치경부cN0갑상선유두상암환자적림상병리특정、수술방식급예후。결과중앙구림파결은닉성전이솔위61．0％。양성림파결수1～13매，평균2．47매，기중＜3매54례，≥3매29례。다인소분석현시，년령화피막외침범위중앙구림파결전이적독립영향인소（균P＜0．05）。전조환자적10년생존솔위98．4％，10년경측구림파결루적복발전이솔위23．4％。다인소분석현시，피막외침범、중앙구양성림파결수위경측구림파결복발적독립영향인소（균P＜0．05）。경측구림파결복발전이적주요부위의차위Ⅳ구（14례，82．4％）、Ⅲ구（11례，64．7％）、Ⅱ구（5례，29．4％）화Ⅴ구（2례，11．8％）。결론 cN0갑상선유두상암응상규행지소일측중앙구림파결청소。응중시대cN0갑상선유두상암경측구적처리，우기시갑상선피막외침범혹중앙구전이림파결수≥3매시。Ⅲ、Ⅳ구응위선택성경측구청소적주요구역。
Objective To retrospectively analyze the long?term results of prophylactic central lymph node dissection in cN0 papillary thyroid carcinoma ( PTC), and investigate the treatment method of the cervical lymph nodes for cN0 PTC. Methods One hundred and thirty?six patients with cN0 PTC were treated by surgery at the Cancer Hospital of Chinese Academy of Medical Sciences from 2000 to 2006. Their clinicopathological characteristics, surgical procedures and survival outcomes were collected and analyzed. Results The occult lymph node metastasis rate in central compartment was 61.0%. The average number of positive lymph nodes was 2.47 (1?13), in which 54 patients had 1?2 and 29 patients had≥3 positive lymph nodes. Multiple logistic regression analysis showed that age less than 45 ( P=0. 001, OR 3. 571, 95% CI 1.681?7.587) and extracapsular spread ( ECS) ( P=0.015,OR 2.99, 95% CI 1.241?7.202) were independent risk factors for lymph node metastasis in the central compartment. The ten?year cumulative overall survival rate was 98. 3% and cumulative lateral neck metastasis rate was 25. 2%. Multivariate analysis with Cox regression model showed that ECS( P=0.001,OR 5.211, 95% CI1.884?14.411) and positive lymph nodes in the central compartment≥3 ( P=0.009,OR 4.005, 95% CI 1.419?11.307) were independent risk factors for lymph node recurrence in the lateral neck region. The distribution of recurrent lymph nodes: level Ⅳ(82.4%), level Ⅲ (64.7%), level Ⅱ (29.4%) and level Ⅴ (11.8%). Conclusions Routine central lymph node dissection, at least unilateral, should be conducted for cN0 papillary thyroid carcinoma. Attention should be paid to the treatment of lateral neck region in patients with cN0 papillary thyroid carcinoma. Selective neck dissection is suggested for cN0 PTC with ECS or positive central lymph nodes≥3, or both. The range of dissection should include level Ⅲ and Ⅳ at least.