Factors Predictive of Papillary Thyroid Micro-carcinoma with Bilateral Involvement and Central Lymph Node Metastasis:a Retrospective Study

【作者】 周毅力； 戴璇璇； 张筱骅； 王瓯晨；

【机构】 温州医学院附属一院肿瘤外科；

【摘要】 <正>Background The optimal resection extent for papillary thyroid microcarcinoma(PTMC) remains controversial. The objective of the study was to investigate risk factors of bilateral PTMC and central lymph node metastasis(CLNM) to guide surgical strategies for PTMC patients. Methods We retrospectively reviewed 211 PTMC patients who underwent total thyroidectomy(TT) and 122 clinical lymph node-negative(cNO) cases who underwent prophylactic central lymph node dissection(CLND) between 2010 and 2011.The frequency,pat-tern,and predictive factors for bilateral PTMC and CLNM in these patients were studied using univariate and multivariate analysis with respect to the following vari-ables:age,gender,extrathyroidal extension(ETE),T stage,with Hashimoto thyroidi-tis(HT),tumor size and multifocality based on final pathology and preoperative evaluation using ultrasonography(US). Results 54 of 211(25.6%) patients had bilateral PTMC.In multivariate analysis,multifocality (p<0.001,OR=23.900) and tumor size≥7mm(p=0.014,OR=2.398) based on US were independent predictive factors for bilateral PTMC which was also independently as-sociated with multifocality(p<0.001,OR=29.657) and tumor size≥7mm(p=0.005,OR=2.863) based on final pathology.Among 122 cNO patients who under-went prophylactic CLND, we found 49.2%of patients had CLNM.CLNM was inde-pendently associated with men,age<50 years and tumor size≥7mm based on final pathology or preoperative US. Conclusions TT should be considered for PTMC patients who are found multifocality and tumor size≥7mm based on preoperative US.CLND need be considered in cNO patients who are men,age<50 years or tumor size≥7mm based on preoperative US.更多还原

【Abstract】 Background The optimal resection extent for papillary thyroid microcarcinoma(PTMC) remains controversial. The objective of the study was to investigate risk factors of bilateral PTMC and central lymph node metastasis(CLNM) to guide surgical strategies for PTMC patients. Methods We retrospectively reviewed 211 PTMC patients who underwent total thyroidectomy(TT) and 122 clinical lymph node-negative(cNO) cases who underwent prophylactic central lymph node dissection(CLND) between 2010 and 2011.The frequency,pat-tern,and predictive factors for bilateral PTMC and CLNM in these patients were studied using univariate and multivariate analysis with respect to the following vari-ables:age,gender,extrathyroidal extension(ETE),T stage,with Hashimoto thyroidi-tis(HT),tumor size and multifocality based on final pathology and preoperative evaluation using ultrasonography(US). Results 54 of 211(25.6%) patients had bilateral PTMC.In multivariate analysis,multifocality (p<0.001,OR=23.900) and tumor size≥7mm(p=0.014,OR=2.398) based on US were independent predictive factors for bilateral PTMC which was also independently as-sociated with multifocality(p<0.001,OR=29.657) and tumor size≥7mm(p=0.005,OR=2.863) based on final pathology.Among 122 cNO patients who under-went prophylactic CLND, we found 49.2%of patients had CLNM.CLNM was inde-pendently associated with men,age<50 years and tumor size≥7mm based on final pathology or preoperative US. Conclusions TT should be considered for PTMC patients who are found multifocality and tumor size≥7mm based on preoperative US.CLND need be considered in cNO patients who are men,age<50 years or tumor size≥7mm based on preoperative US.更多还原