Abstract:

Predictive factors of rVIb metastasis and the correlation between rVIa and rVIb metastasis in papillary thyroid microcarcinoma        LIU Wen, CHENG Ruo-chuan, SU Yan-jun, et al. Department of Thyroid Surgery, the First Affiliated Hospital of Kunming Medical University, Kunming 650032, China
Corresponding author：CHENG Ruo-chuan, E-mail：cruochuan@foxmail.com
Abstract    Objective    To investigate the predictive factors of lymph node metastasis of deep surface （rⅥb） of the right recurrent laryngeal nerve （rRLN） in papillary thyroid microcarcinoma （PTMC）patients， and the correlation between rRLN superficial surface （rⅥa） and rⅥb lymph node metastasis in the patients. Methods    Based on metastasis in rⅥb， 772 PTMC patients admitted in the First Affiliated Hospital of Kunming Medical Universityfrom July 2013 to June 2016 were divided into two groups. χ2 test and multivariate logistic regression were used to analyze the risk factors of rⅥb metastasis. Results    The rⅥb metastasis rate was 7.1% （55/772）. Univariate analysis showed that the factors that correlated with rⅥb metastasis were gender， age， tumor size， tumor location， extrathyroid invasion，metastasis of left central area  + rⅥa， lateral lymph node metastasis （LLNM）， combined with nodular goiter， the right tumor location， rⅥa lymph node metastasis， and metastasis number and ratio. Multivariate analysis showed that male， extrathyroid extension， rⅥa metastasis， LLNM and right tumor region were independent predictive factors of rⅥb. Conclusion Clinical and pathological factors have certain predictive value for Ⅵa metastasis of PTMC. The risk of lymph node metastasis in rⅥb was increased by 8.4 times and by 10.9 times when the metastatic lymph node ≥2 and metastasis ratio of rⅥa was ＞60% respectively. Patients with high risk in rⅥb should be chosen for more complete rⅥb including central lymph node dissection.

Key words: papillary thyroid microcarcinoma, deep lymph nodes of recurrent laryngeal nerve, central lymph node dissection, rⅥb lymph node metastasis

摘要：

目的    探讨甲状腺微小乳头状癌（PTMC）病人右侧喉返神经（rRLN）深面（rⅥb区）淋巴结转移的预测因素和PTMC病人rRLN浅面（rⅥa区）、rⅥb区淋巴结转移相关性。方法    回顾性分析2013年7月至2016年6月昆明医科大学第一附属医院收治的772例PTMC病人资料，根据rⅥb区是否转移分为两组，分析两组病人临床病理特征。应用χ2检验和多因素Logistic回归模型分析rRLN深面淋巴结转移的危险因素。结果    rⅥb区转移发生率为7.1%（55/772）。单因素分析显示性别（P＜0.001）、年龄（P=0.005）、肿瘤大小（P=0.018）、肿瘤位置（P=0.008）、腺外浸润（P＜0.001）、左中央区+rⅥa区转移（P＜0.001）、侧方淋巴结转移（LLNM）（P＜0.001）、合并结节性甲状腺肿（P=0.035）、右侧肿瘤所在区域（P=0.014）、rⅥa区淋巴结转移（P＜0.001）及其转移数量（P＜0.001）、比率（P＜0.001）均与rⅥb区转移相关，与多灶性（P=0.881）、右侧多灶（P=0.693）、合并桥本甲状腺炎（P=0.971）不相关。多因素Logistic回归分析显示男性、腺外浸润、rⅥa区转移、LLNM和右侧肿瘤区域是rⅥb区的独立预测因素。结论临床病理学因素对PTMC rⅥa区转移有一定的预测价值，当rⅥa区转移淋巴结≥2枚和发生率＞60%时，rⅥb区淋巴结转移风险分别升高8.4倍和10.9倍。在保证安全的前提下，应对rⅥb区高风险病人选择更为彻底的中央区淋巴结清扫（包含rⅥb区在内）。

关键词: 甲状腺微小乳头状癌, 喉返神经深面淋巴结, 中央区淋巴结清扫, rⅥb区淋巴结转移