Metastatic Pattern and Influencing Factors of Cervical Lymph Node in Papillary Thyroid Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

GAO Qingjun , WANG Nanpeng , ZHOU Yan , DUAN Haisong , GAO Rongjun ,  ZHAO Daiwei , GONG Weidong , HUANG Kun

Department of Thyroid Surgery， Affiliated Hospital of Guiyang Medical College， Guiyang 550004， Guizhou Province， China;

Corresponding author：

ZHAO Daiwei, Email: zhaodw@hotmail.com

Keywords：

Papillary thyroid carcinoma; Neck dissection; Lymph node metastasis

DOI：

10.7507/1007-9424.20130076

Video：

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Objective　To explore the pattern and clinical influencing factors of cervical lymph node metastasis in papillary thyroid carcinoma （PTC）， and provide a basis for the choice of surgical approach for the PTC neck lymph node processing.
Methods　The clinical data of 98 patients with PTC treated in Affiliated Hospital of Guiyang Medical College from Jan. 2009 to Dec. 2011 were collected， and the pattern and clinical influencing factors of cervical lymph node metastasis were analyzed.
Results　Ninety eight consecutive patients underwent neck dissection in a total of 114 sides. The lymph node metastasis rate of cervical lymph node， districtⅥ， districtⅡ＋Ⅲ＋Ⅳ， and districtⅤwas 77.55% （76/98）， 74.49% （73/98）， 42.86% （42/98）， and 5.10% （5/98）， respectively. Results of univariate analysis showed that lymph node metastasis rates were higher in patients with diameter of tumor greater than 1 cm， tumor invaded thyroid capsule， multi-focal tumor， and old than 45 years （P＜0.05）. Results of multivariate analysis showed that the age of patients， diameter of tumor， tumor invaded thyroid capsule， and multifocal tumor were independent risk factors of cervical lymph node metastasis （P＜0.05）. Tumor invaded thyroid capsule， multifocal tumor， combined with districtⅥmetastasis， and combined with districtⅡ＋Ⅲ＋Ⅳ metastasis were independent risk factors of prelaryngeal lymph node metastasis （P＜0.05）. Tumor invaded thyroid capsule and multifocal tumor were independent risk factors of skip lymph node metastasis （P＜0.05）.
Conclusions　DistrictⅥ is found to be the predominant site for lymph node metastasis of PTC， the districtⅢ and the districtⅣinvolved in addition， so it is necessary to clean lymph nodes at districtⅥ routinely. The regularity of cervical lymph node metastasis can provide the basis for surgeon to choose a reasonable type of neck dissection.

Citation： GAO Qingjun,WANG Nanpeng,ZHOU Yan,DUAN Haisong,GAO Rongjun,ZHAO Daiwei,GONG Weidong,HUANG Kun,.. Metastatic Pattern and Influencing Factors of Cervical Lymph Node in Papillary Thyroid Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2013, 20(3): 303-309. doi: 10.7507/1007-9424.20130076 Copy

1.	姜军，李世超. 分化型甲状腺癌淋巴结转移特点及颈侧方淋巴结清扫术局部应用解剖[J] . 中国实用外科杂志， 2011， 31(5)：380-383.
2.	Roh JL， Kim JM， Park CI. Lateral cervical lymph node metastasesfrom papillary thyroid carcinoma：pattern of nodal metastases and optimal strategy for neck dissection[J]. Ann Surg Oncol， 2008， 15(4)：1177-1182.
3.	张广，张纯海，付言涛，等. 甲状腺炎合并甲状腺癌颈淋巴结转移情况及相关因素探讨[J]. 中国普外基础与临床杂志， 2011， 18(6)：625-628.
4.	刘永锋. 加强分化型甲状腺癌的规范化治疗[J]. 中国普外基础与临床杂志， 2009， 16(5)：341-343.
5.	Caron NR， Tan YY， Ogilvie JB， et al. Selective modified radical neck dissection for papillary thyroid cancer——is levelⅠ，ⅡandⅤ dissection always necessary?[J]. World J Surg， 2006， 30(5)：833-840.
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9.	Baek SK， Jung KY， Kang SM， et al. Clinical risk factors associ-ated with cervical lymph node recurrence in papillary thyroid carci-noma[J]. Thyroid， 2010， 20(2)：147-152.
10.	Bardet S， Malville E， Rame JP， et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma[J]. Eur J Endocrinol， 2008， 158(4)：551-560.
11.	Hay ID， Hutchinson ME， Gonzalez-Losada T， et al. Papillary thyroid microcarcinoma：a study of 900 cases observed in a 60-yearperiod[J]. Surgery， 2008， 144(6)：980-988.
12.	林益凯，盛建明，赵文和，等. 多灶性甲状腺乳头状癌168例临床研究[J]. 中华外科杂志， 2009， 47(6)：450-453.
13.	Lim DJ， Baek KH， Lee YS， et al. Clinical， histopathological， and molecular characteristics of papillary thyroid microcarcinoma[J]. Thyroid， 2007， 17(9)：883-888.
14.	Lin JD， Chao TC， Hsueh C， et al. High recurrent rate of multicentric papillary thyroid carcinoma[J]. Ann Surg Oncol， 2009， 16(9)：2609-2616.
15.	British Thyroid Association， Royal College of Physicians. Guidelines for the management of thyroid cancer. Report of the thyroid cancer guidelines update group[M]. 2th ed. London：Royal College of Physicians， 2007：12-17.
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17.	方国恩，陈琳. 甲状腺癌颈淋巴结清扫术的评价[J]. 中国实用外科杂志， 2004， 24(10）：587-589.
18.	Ito Y， Tomoda C， Uruno T， et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid[J]. World J Surg， 2006， 30(1)：91-99.
19.	Kowalski LP， Concalves Filho J， Pinto CA， et al. Long-term survival rates in young patients with thyroid carcinoma[J]. Arch Otolaryngol Head Neck Surg， 2003， 129(7)：746-749.
20.	马宏岩，李迅庚. 甲状腺乳头状癌选择性颈淋巴结清除术的临床研究[J]. 中华肿瘤防治杂志， 2008， 15(6)：453-455.
21.	Wardl S， Souza SL， Assupmc OLV. The impact of nodal metastases on prognosis of well differentiated thyroid cancer suggests the practice of prophylactic neck dissection[J]. Arch Otolaryngol Head Neck Surg， 2003， 129(4)：495-496.
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24.	Mazzaferri EL， Jhiang SM. Long-term impact of initial surgicaland medical therapy on papillary and follicular thyroid cancer[J].Am J Med， 1994， 97(5)：418-428.
25.	Noguchi M， Kumaki T， Taniya T， et al. Bilateral cervical lymph node metastases in well-differentiated thyroid cancer[J]. Arch Surg， 1990， 125(6)：804-806.
26.	-531.

1. 姜军，李世超. 分化型甲状腺癌淋巴结转移特点及颈侧方淋巴结清扫术局部应用解剖[J] . 中国实用外科杂志， 2011， 31(5)：380-383.
2. Roh JL， Kim JM， Park CI. Lateral cervical lymph node metastasesfrom papillary thyroid carcinoma：pattern of nodal metastases and optimal strategy for neck dissection[J]. Ann Surg Oncol， 2008， 15(4)：1177-1182.
3. 张广，张纯海，付言涛，等. 甲状腺炎合并甲状腺癌颈淋巴结转移情况及相关因素探讨[J]. 中国普外基础与临床杂志， 2011， 18(6)：625-628.
4. 刘永锋. 加强分化型甲状腺癌的规范化治疗[J]. 中国普外基础与临床杂志， 2009， 16(5)：341-343.
5. Caron NR， Tan YY， Ogilvie JB， et al. Selective modified radical neck dissection for papillary thyroid cancer——is levelⅠ，ⅡandⅤ dissection always necessary?[J]. World J Surg， 2006， 30(5)：833-840.
6. Roti E， Rossi R， Trasforini G， et al. Clinical and histological characteristics of papillary thyroid microcarcinoma：results of a retrospective study in 243 patients[J]. J Clin Endocrinol Metab， 2006， 91(6)：2171-2178.
7. Machens A， Holzhausen HJ， Dralle H. The prognostic value ofprimary tumor size in papillary and follicular thyroid carcinoma[J]. Cancer， 2005， 103(11)：2269-2273.
8. 李治，刘春萍，屈新才，等. 乳头状甲状腺癌的颈部淋巴结转移规律与手术方式[J]. 中国普通外科杂志， 2008， 17(11)：1051-1053.
9. Baek SK， Jung KY， Kang SM， et al. Clinical risk factors associ-ated with cervical lymph node recurrence in papillary thyroid carci-noma[J]. Thyroid， 2010， 20(2)：147-152.
10. Bardet S， Malville E， Rame JP， et al. Macroscopic lymph-node involvement and neck dissection predict lymph-node recurrence in papillary thyroid carcinoma[J]. Eur J Endocrinol， 2008， 158(4)：551-560.
11. Hay ID， Hutchinson ME， Gonzalez-Losada T， et al. Papillary thyroid microcarcinoma：a study of 900 cases observed in a 60-yearperiod[J]. Surgery， 2008， 144(6)：980-988.
12. 林益凯，盛建明，赵文和，等. 多灶性甲状腺乳头状癌168例临床研究[J]. 中华外科杂志， 2009， 47(6)：450-453.
13. Lim DJ， Baek KH， Lee YS， et al. Clinical， histopathological， and molecular characteristics of papillary thyroid microcarcinoma[J]. Thyroid， 2007， 17(9)：883-888.
14. Lin JD， Chao TC， Hsueh C， et al. High recurrent rate of multicentric papillary thyroid carcinoma[J]. Ann Surg Oncol， 2009， 16(9)：2609-2616.
15. British Thyroid Association， Royal College of Physicians. Guidelines for the management of thyroid cancer. Report of the thyroid cancer guidelines update group[M]. 2th ed. London：Royal College of Physicians， 2007：12-17.
16. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer；Cooper DS，Doherty GM， et al. Revised American thyroid association manag-ement guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid， 2009， 19(11)：1167-1214.
17. 方国恩，陈琳. 甲状腺癌颈淋巴结清扫术的评价[J]. 中国实用外科杂志， 2004， 24(10）：587-589.
18. Ito Y， Tomoda C， Uruno T， et al. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid[J]. World J Surg， 2006， 30(1)：91-99.
19. Kowalski LP， Concalves Filho J， Pinto CA， et al. Long-term survival rates in young patients with thyroid carcinoma[J]. Arch Otolaryngol Head Neck Surg， 2003， 129(7)：746-749.
20. 马宏岩，李迅庚. 甲状腺乳头状癌选择性颈淋巴结清除术的临床研究[J]. 中华肿瘤防治杂志， 2008， 15(6)：453-455.
21. Wardl S， Souza SL， Assupmc OLV. The impact of nodal metastases on prognosis of well differentiated thyroid cancer suggests the practice of prophylactic neck dissection[J]. Arch Otolaryngol Head Neck Surg， 2003， 129(4)：495-496.
22. Podnos YD， Smith D， Wagman LD， et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer[J]. Am Surg， 2005， 71(9)：731-734.
23. Lundgren CI， Hall P， Dickman PW， et al. Clinically significantprognostic factors for differentiated thyroid carcinoma：a popula-tion-based， nested case-control study[J]. Cancer， 2006， 106(3)：.
24. Mazzaferri EL， Jhiang SM. Long-term impact of initial surgicaland medical therapy on papillary and follicular thyroid cancer[J].Am J Med， 1994， 97(5)：418-428.
25. Noguchi M， Kumaki T， Taniya T， et al. Bilateral cervical lymph node metastases in well-differentiated thyroid cancer[J]. Arch Surg， 1990， 125(6)：804-806.
26. -531.

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Metastatic Pattern and Influencing Factors of Cervical Lymph Node in Papillary Thyroid Carcinoma

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