世界肿瘤杂志

.2023年8月17日；21（1）：249。doi:10.1186/s12957-023-03075-w。

pN1b甲状腺乳头状癌IIB和对侧VI级淋巴结转移模式及II级颈清扫低领扩大切口的安全性

宁1号、刘2号、曾定芬1号、周玉秋1号、马林杰1号、董爽1号、盛3号、吴高松4号、

田5号、蔡永聪6号、李超7号

附属关系扩展

PMID:37592337 PMCID:PMC10433677 DOI:10.1186/s12957-023-03075-w

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摘要

目的：探讨ⅡB级和对侧Ⅵ级淋巴结转移的相关临床因素，评价pN1b甲状腺乳头状癌

Ⅱ级淋巴结清扫低领扩大切口（LCEI）的安全性。

方法：对四川省癌症医院头颈外科中心2021年9月至2021年3月收治的218例pN1b型

PTC患者进行回顾性分析。

摘要

目的：探讨ⅡB级和对侧Ⅵ级淋巴结转移的相关临床因素，评价pN1b甲状腺乳头状癌

Ⅱ级淋巴结清扫低领扩大切口（LCEI）的安全性。

方法：对2021年9月至2022年5月在四川省癌症医院头颈外科中心手术治疗的218例

pN1b PTC患者进行回顾性分析。收集年龄、性别、体重指数（BMI）、肿瘤位置、

最大肿瘤直径、多灶性、Braf基因、T分期、手术切口类型和每个宫颈亚区的淋巴结

转移等数据。卡方检验用于相关因素的比较分析。所有统计分析均采用SPSS 24软件完成。

结果：III、IV和V级各亚组在性别、年龄、BMI、多灶性、肿瘤位置、甲状腺外延伸、

Braf基因和淋巴结转移方面均无差异。

结果：Ⅲ、Ⅳ、Ⅴ级各亚组在性别、年龄、BMI、多灶性、肿瘤部位、甲状腺外延伸、

Braf基因、淋巴结转移等方面，ⅡB级淋巴结转移阳性率无显著性差异（P>0.05），

双侧颈外侧淋巴结转移患者比单侧颈外侧淋巴管转移患者更有可能发生IIB级淋巴结转移，

差异有统计学意义（P=0.000），IIA级淋巴结转移与IIB级淋巴结结转移独立相关

（P=0.010）。LCEI组IIA级和IIB级的淋巴结转移数和淋巴结转移率与L形切口组相似（P>0.05）

同侧中心淋巴结转移86例（78.2%），对侧中心淋巴转移占56.4%，对侧中央淋巴结转移率

与年龄、体重指数、多灶性、肿瘤侵袭性或同侧中央淋巴转移无关，男性对侧中央淋巴结

转移率略高于女性，差异有统计学意义（68.2%对48.5%，P=0.041）。

结论：IIA淋巴结转移是IIB淋巴结转移的独立预测因子。当发现双侧颈外侧淋巴结转移或IIA级

淋巴结转移时，强烈建议进行IIB级淋巴结清扫。当单侧颈外侧淋巴结转移和IIA级淋巴结转移

均为阴性时，可在术后适当行IIB级淋巴结清扫。

同侧中心淋巴结转移86例（78.2%）对侧中心淋巴转移占56.4%对侧中央淋巴结转移率与年龄、

体重指数、多灶性、肿瘤侵袭性或同侧中央淋巴转移无关，男性对侧中央淋巴结转移率略高于

女性，差异有统计学意义（68.2%对48.5%，P=0.041）。

结论：IIA淋巴结转移是IIB淋巴结转移的独立预测因子。当发现双侧颈外侧淋巴结转移或IIA级

淋巴结转移时，强烈建议进行IIB级淋巴结清扫。当单侧颈外侧淋巴结转移和IIA级淋巴结转移

均为阴性时，可在术后适当行IIB级淋巴结清扫。

https://pubmed.ncbi.nlm.nih.gov/37592337/

Abstract

Objective: To explore relevant clinical factors of level IIB and contralateral level VI lymph node metastasis and evaluate the safety of low-collar extended incision (LCEI) for lymph node dissection in level II for papillary thyroid carcinoma (PTC) with pN1b.

Method: A retrospective analysis was performed on 218 patients with PTC with pN1b who were treated surgically in the Head and Neck Surgery Center of Sichuan Cancer Hospital from September 2021 to May 2022. Data on age, sex, body mass index (BMI), tumor location, maximum tumor diameter, multifocality, Braf gene, T staging, surgical incision style, and lymph node metastasis in each cervical subregion were collected. The chi-square test was used for comparative analysis of relevant factors. All statistical analyses were completed by SPSS 24 software.

Result: Each subgroup on sex, age, BMI, multifocality, tumor location, extrathyroidal extension, Braf gene, and lymphatic metastasis in level III, level IV, and level V had no significant difference in the positive rate of lymph node metastasis in level IIB (P > 0.05). In contrast, patients with bilateral lateral cervical lymphatic metastasis were more likely to have level IIB lymphatic metastasis than those with unilateral lateral cervical lymphatic metastasis, with a statistically significant difference (P = 0.000). In addition, lymph node metastasis in level IIA was significantly associated with lymph node metastasis in level IIB (P = 0.001). After multivariate analysis, lymph node metastasis in level IIA was independently associated with lymph node metastasis in level IIB (P = 0.010). The LCEI group had a similar lymphatic metastasis number and lymphatic metastasis rate in both level IIA and level IIB as the L-shaped incision group (P > 0.05). There were 86 patients with ipsilateral central lymphatic metastasis (78.2%). Patients with contralateral central lymphatic metastasis accounted for 56.4%. The contralateral central lymphatic metastasis rate was not correlated with age, BMI, multifocality, tumor invasion, or ipsilateral central lymphatic metastasis, and there was no significant difference (P > 0.05). The contralateral central lymphatic metastasis in males was slightly higher than that in females, and the difference was statistically significant (68.2% vs. 48.5%, P = 0.041).

Conclusion: Lymphatic metastasis in level IIA was an independent predictor of lymphatic metastasis in level IIB. When bilateral lateral cervical lymphatic metastasis or lymph node metastasis of level IIA is found, lymph node dissection in level IIB is strongly recommended. When unilateral lateral cervical lymphatic metastasis and lymphatic metastasis in level IIA are negative, lymph node dissection in level IIB may be performed as appropriate on the premise of no damage to the accessory nerve. LCEI is safe and effective for lymph node dissection in level II. When the tumor is located in the unilateral lobe, attention should be given to contralateral central lymph node dissection because of the high lymphatic metastasis rate.

Keywords: Contralateral central lymphatic metastasis; Lateral cervical lymphatic metastasis; Low-collar extended incision; Papillary thyroid carcinoma.

© 2023. BioMed Central Ltd., part of Springer Nature.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1 

A (right) An L-shaped incision…

Fig. 2 

A Anatomical display after dissection…

Fig. 3 

Radar map:the percentage of lymph…

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MeSH terms

• Carcinoma*

• Female

• Humans

• Lymphatic Metastasis

• Male

• Neck Dissection

• Proto-Oncogene Proteins B-raf / genetics

• Retrospective Studies

• Thyroid Cancer, Papillary / surgery

• Thyroid Neoplasms* / surgery

• Uterine Cervical Neoplasms*

Substances

• Proto-Oncogene Proteins B-raf

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Grants and funding

• 2022-YF05-01847-SN/Chengdu Science and Technology Bureau technology innovation research and development project--Research on the establishment and application of the REDCap thyroid cancer data management platform

• 2022-YF05-01847-SN/Chengdu Science and Technology Bureau technology innovation research and development project--Research on the establishment and application of the REDCap thyroid cancer data management platform

• 2022-YF05-01847-SN/Chengdu Science and Technology Bureau technology innovation research and development project--Research on the establishment and application of the REDCap thyroid cancer data management platform

• 2022-YF05-01847-SN/Chengdu Science and Technology Bureau technology innovation research and development project--Research on the establishment and application of the REDCap thyroid cancer data management platform

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