Analysis Of Influence Factors On The Central Cervical Lymph Nodes Metastasis And Recurrence Of PTMC

OBJECTIVE: To discuss the appropriate operation method for PTMC and thecategories of patients to follow up frequently after operation through the research onfactors influencing metastasis of central cervical lymph nodes and the recurrence asthe morbidity of PTMC has been rising year by year. However, there has been noconsensus on operative treatment of PTMC reached in China up to the present.METHOD: Retrospectively analyze140patients with PTMC, who acceptedoperative treatment with dissection of central cervical lymph nodes between Apr.2012and Mar.2013, make statistics of age, gender, pathological features,preoperative ultrasonic diagnosis result, operation type and situation in recurrence andalso discuss the relationship between the patients’ clinical characteristics andmetastasis and recurrence of central cervical lymph nodes, and let patients takelevothyroxine sodium tablets to inhibit internal secretion and conduct periodic reviewof color Doppler ultrasonic after operation.RESULT: Among140patients with PTMC, of which53came down withcervical lymph node metastasis, whose rate was37.9%(53/140);19with metastasisof both central and lateral cervical lymph nodes, whose rate was13.6(19/140);28only with metastasis of central cervical lymph nodes, whose rate was20.0%(28/140) while6only with metastasis of lateral cervical lymph nodes, whose rate was4.3%(6/140).Only with considerations given into metastasis of central cervical lymph nodes,there were47cases of positive patients; metastasis rate was33.6%(47/140); when theage was＜45years old, the metastasis rate was41.8%(28/67); when the age≥45years old, the metastasis rate was26.00%(19/73). For the patients with multifocal,the metastasis rate was44.9%(22/49); for those with monofocal, the metastasis ratewas27.5%(25/91); for those with invasion of the thyroid capsule, the metastasis ratewas77.8%(7/9), for those without invasion of the thyroid capsule, the metastasis ratewas30.5%(40/131). For those with the capsule of focal, the metastasis rate was0(0/8); for those without the capsule of focal, the metastasis rate was35.6%(47/132).For those with invasion of tissues in gland, the metastasis rate was43.9%(36/82); forthose with clear boundary between the focal and tissues in gland, the metastasis ratewas19.0%(11/58). The metastasis of lymph nodes in central cervical lymph nodes ofPTMC is associated with age＜45years old, multifocal, invasion of the thyroidcapsule, focal without capsule structure and unclear boundary of focal and tissue ofthyroid gland (p＜0.05) but not associated with gender, size of tumor, whether with orwithout hashimoto’s disease, whether preoperative diagnosis was benign disease butdiscovered accidentally during operation or after operation,and whether there islymph node metastasis according to the preoperative ultrasonic diagnosis (p＞0.05).When there is metastasis of central cervical lymph nodes according tointraoperative frozen pathological diagnosis and apparently swelling lumps could betouched in the lateral cervical, dissection of lateral cervical lymph nodes could beconducted. The patients with metastasis of lymph nodes in central and lateral cervicalaccounted for13.6%(19/140) of the total, those with metastasis of lymph nodes incentral cervical but in lateral cevical accounted for20%(28/140) of the total whilethose without metastasis of lymph nodes in central cervical but in lateral cervicalaccounted for4.3%(6/140) of the total. Through correlation analysis of2×2matcheddata on the relationship between the metastasis of lymph nodes in central region and lateral neck region, the result showed P＜0.05, indicating the metastasis of lymphnodes in central cervical might lead to that in lateral cervical.The recurrence of PTMC patients accounted for5.0%(7/140)of the total. Therecurrence of the multifocal accounted for12.2%(6/49), the monofocal accounted for1.1%(1/91). The recurrence of metastasis of lateral cervical lymph nodes accountedfor16.0%(4/25), negative of lateral cervical lymph nodes accounted for2.6%(3/155).The recurrence of PTMC is associated with the multifocal and metastasis of lymphnodes in lateral cervical. The recurrence is not associated with the operation method.Under the situation that there is no node left when the affected lobe(s) beenremoved, we have five kind of operation methods. The recurrence of Totalthyroidectomy accounted for6.0%(4/67), Near-total thyroidectomy accounted for0(0/3),Sub-total thyroidectomy accounted for10.7%(3/28),Lobectomy+isthmusectomy accounted for0(0/7),Lobectomy+isthmusectomy+”part-of-the-other-lobectomy” accounted for0(0/35).CONCLUSION: If the patients with PTMC have any of the following situationssuch as: age＜45years old, multifocal, invasion of the thyroid capsule, focal withoutcapsule and unclear boundary of focal and thyroid tissue, the considerations should begiven to conduct prophylactic dissection of lymph nodes in central cervical. Therecurrence rate of patients with multifocal or the metastasis of the lateral cervicallymph nodes is high. The considerations should be given to conduct dissection oflymph nodes in lateral cervical in case of metastasis of lymph nodes in centralcervical. We should treat the patient separately, and prevent the patients with low riskin metastasis of cervical lymph nodes from more aggressive operation methods.