单侧甲状腺乳头状癌Delphian淋巴结转移的发生率及其临床意义

doi:10.16139/j.1007-9610.2021.05.017

摘要/Abstract

摘要：

目的：探究喉前淋巴结（Delphian lymph node, DLN）转移在单侧甲状腺乳头状癌（papillary thyroid carcinoma, PTC）病人中的发生率及其临床意义。方法：回顾性分析我科2016年1月至2019年12月收治522例单侧PTC病人的临床病理资料。分析DLN转移与病人年龄、性别、肿瘤大小、肿瘤多灶性、包膜侵犯、腺体外侵犯、肿瘤位置、中央区淋巴结转移（除外DLN）和侧颈区淋巴结转移的关系。结果：522例中,133例（25.5%）DLN转移。年龄（P=0.047）、性别（P<0.001）、肿瘤最大径（P<0.001）、包膜侵犯（P<0.001)、腺体外侵犯（P=0.004)、肿瘤位置（P=0.003）、中央区淋巴结转移（P<0.001）及其数目（除外DLN）（P<0.001）、侧颈区淋巴结转移（P=0.036）及其数目（P=0.004）、DLN切除数目（P=0.043）与DLN转移相关。结论：DLN转移与PTC的一些不良预后因素显著相关。如术中冷冻病理检查结果提示DLN转移阳性,需仔细清扫并评估中央区淋巴结以及侧颈区淋巴结,密切随访。

关键词: 喉前淋巴结, 甲状腺乳头状癌, 转移

Abstract: Objects To study the incidence of Delphian lymph node (DLN) metastasis in patients with unilateral pa-pillary thyroid carcinoma (PTC) and the clinical significance. Methods The clinicopathological data of 522 patients with unilateral PTC in our hospital between January 2016 and December 2019 were analyzed retrospectively. The association between DLN metastasis and the clinicopathological characteristics including age, sex, tumor size, multifocality, capsular invasion, extrathyroidal extension, tumor location, central lymph node (CLN) metastasis (excluding DLN), and lateral lymph node metastasis was analyzed. Results One hundred thirty-three(25.5%) of 522 patients had DLN metastasis. It was significant that DLN metastasis was associated with age (P=0.047), male (P<0.001), larger tumor size (P<0.001), capsular invasion (P<0.001), extrathyroidal extension (P=0.004), tumor location (P=0.003), CLN metastasis (P<0.001), number of positive CLN (excluding DLN) (P<0.001), lateral compartment lymph node (LLN) metastasis (P=0.036), number of positive LLN (P=0.004) and number of DLN removed (P=0.043). Conclusions The DLN metastasis was shown to be associated significantly with several factors of poor PTC prognosis. When the DLN of intraoperative frozen section is positive, careful dissection and evaluation of CLN and LLN are essential with necessary follow-up.

Key words: Delphian lymph node, Papillary thyroid cancer, Metastasis

中图分类号:

R736.1

刘威, 王聪, 王正林, 艾志龙. 单侧甲状腺乳头状癌Delphian淋巴结转移的发生率及其临床意义[J]. 外科理论与实践, 2021, 26(05): 445-448.

LIU Wei, WANG Cong, WANG Zhenglin, AI Zhilong. Incidence of Delphian lymph node metastasis in unilateral papillary thyroid carcinoma and clinical significance[J]. Journal of Surgery Concepts & Practice, 2021, 26(05): 445-448.

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参考文献 17

[1]	Shaha AR, Shah JP, Loree TR. Patterns of nodal and distant metastasis based on histologic varieties in diffe-rentiated carcinoma of the thyroid[J]. Am J Surg, 1996, 172(6):692-694. pmid: 8988680
[2]	Schoppy DW, Holsinger FC. Management of the neck in thyroid cancer[J]. Otolaryngol Clin North Am, 2014, 47(4):545-556. doi: 10.1016/j.otc.2014.04.004 URL
[3]	Haugen BR, Alexander EK, Bible KC, et al. 2015 Ame-rican Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2016, 26(1):1-133. doi: 10.1089/thy.2015.0020 URL
[4]	Means J. The thyroid and its diseases[M]. 2nd ed. Philadelphia: JB Lippincott Co., 1948.
[5]	Gawlak-Prycka A. Prelaryngeal lymph node (Delphian) in patients with laryngeal cancer[J]. Otolaryngol Pol, 2001, 55(1):35-41. pmid: 11355474
[6]	Ferlito A, Shaha AR, Rinaldo A. Prognostic value of Delphian lymph node metastasis from laryngeal and hypopharyngeal cancer[J]. Acta Otolaryngol, 2002, 122(4):456-457. doi: 10.1080/00016480260000201 URL
[7]	Isaacs JD, Lundgren CI, Sidhu SB, et al. The Delphian lymph node in thyroid cancer[J]. Ann Surg, 2008, 247(3):477-482. doi: 10.1097/SLA.0b013e31815efdc4 URL
[8]	Iyer NG, Kumar A, Nixon IJ, et al. Incidence and significance of Delphian node metastasis in papillary thyroid cancer[J]. Ann Surg, 2011, 253(5):988-991. doi: 10.1097/SLA.0b013e31821219ca URL
[9]	Kim WW, Yang SI, Kim JH, et al. Experience and ana-lysis of Delphian lymph node metastasis in patients with papillary thyroid carcinoma[J]. World J Surg Oncol, 2012, 10:226. doi: 10.1186/1477-7819-10-226 URL
[10]	Lee YC, Shin SY, Kwon KH, et al. Incidence and clinical characteristics of prelaryngeal lymph node metastasis in papillary thyroid cancer[J]. Eur Arch Otorhinolaryngol, 2013, 270(9):2547-2550. doi: 10.1007/s00405-013-2471-7 URL
[11]	Oh EM, Chung YS, Lee YD. Clinical significance of Delphian lymph node metastasis in papillary thyroid carci-noma[J]. World J Surg, 2013, 37(11):2594-2599. doi: 10.1007/s00268-013-2157-8 URL
[12]	Tan Z, Ge MH, Zheng CM, et al. The significance of Delphian lymph node in papillary thyroid cancer[J]. Asia Pac J Clin Oncol, 2017, 13(5):e389-e393. doi: 10.1111/ajco.12480 URL
[13]	Zheng G, Zhang H, Hao S, et al. Patterns and clinical significance of cervical lymph node metastasis in papillary thyroid cancer patients with Delphian lymph node metastasis[J]. Oncotarget, 2017, 8(34):57089-57098. doi: 10.18632/oncotarget.19047 URL
[14]	Gimm O, Rath FW, Dralle H. Pattern of lymph node metastases in papillary thyroid carcinoma[J]. Br J Surg, 1998, 85(2):252-254. doi: 10.1046/j.1365-2168.1998.00510.x URL
[15]	Qubain SW, Nakano S, Baba M, et al. Distribution of lymph node micrometastasis in pN₀ well-differentiated thyroid carcinoma[J]. Surgery, 2002, 131(3):249-256. doi: 10.1067/msy.2002.120657 URL
[16]	Roh JL, Kim JM, Park CI. Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence[J]. Ann Surg Oncol, 2011, 18(8):2245-2250. doi: 10.1245/s10434-011-1600-z URL
[17]	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.

特征	DLN转移组(n=133)	DLN未转移组(n=389)	P值
年龄 (岁）	41.0±12.3	43.4±11.7	0.047^a）
女/男	64\69	261\128	<0.001^b）
肿瘤最大径（cm）	1.27±0.68	0.92±0.57	<0.001^a）
甲状腺包膜侵犯	84 (63.2)	177 (45.5)	<0.001^b）
甲状腺腺体外侵犯	18 (13.5)	21 (5.4)	0.004^b）
肿瘤多灶	22 (16.5)	58 (14.9)	0.676^b）
肿瘤位置			0.003^b）
上1\3	60 (45.1)	121 (31.1)
中1\3	35 (26.3)	160 (41.1)
下1\3	38 (28.6)	108 (27.8)
CLN*清扫术	133	389
CLN*中位数（四分位数）	5 (2~7)	4 (2~6)	0.140^c）
CLN*转移 (%)	108 (81.2)	161 (41.4)	<0.001^b）
CLN*转移中位数 (四分位数)	2 (1~4)	0 (0~2)	<0.001^c）
CLN*转移密度	0.65	0.16	<0.001^a）
LLN清扫术	30	16
LLN中位数 (四分位数)	21 (15~27)	20 (13.25~23.75)	0.267^c）
LLN转移	29 (96.7)	11 (68.8)	0.036^b）
LLN转移中位数 (四分位数)	4.5 (2.00~7.25)	1.5 (0.25~3.75)	0.004^c）
清扫DLN中位数 (四分位数)	2 (1~3)	2 (1~2)	0.043^c）

研究	时间（年）	纳入对象	DLN（+）	结果
Isaacs等^[7]	2008	87例PTC 16例髓样癌	22例	与肿瘤直径相关与年龄无关
Iyer等^[8]	2011	101例PTC	25例	与腺体外侵犯、CLN、LLN有关与年龄、肿瘤直径无关
Kim等^[9]	2012	308例PTC	53例	与肿瘤直径、多灶性、腺体外侵犯、LLN转移有关与年龄无关
Lee等^[10]	2013	67例PTC	13例	与肿瘤直径、、腺体外侵犯、CLN及LLN转移有关与年龄、性别、多灶性无关
Oh等^[11]	2013	245例PTC	49例	与性别、肿瘤直径、多灶性、CLN及LLN转移有关与年龄无关
Tan等^[12]	2017	231例PTC	19例	与肿瘤直径、腺体外侵犯、CLN及LLN转移有关与性别、多灶性无关
Zheng等^[13]	2017	206例PTC	42例	与肿瘤直径、多灶性、腺体外侵犯、CLN转移有关与性别无关