Analysis Of Central Lymph Node Metastasis In CN0 Thyroid Papillary Carcinoma

Objective:Early stage of papillary thyroid carcinoma(PTC)can metastasize to the cervical lymph nodes through the glandular lymphatic vessels.Whether the cN0 stage PTC should be used to prevent the central lymph node from being cleared,both at home and abroad Controversial.This article aims to investigate the incidence of central lymph node metastasis(CLNM)in patients with cN0 stage PTC,the related risk factors,the incidence of surgical complications,and the prognosis,as an individualized and accurate prevention of central lymph node during surgery.Prophylactic central node dissection(p-CND)provides a certain clinical basis.Methods:1.Collection of clinically relevant data from January 2015 to December 2016 in our head and neck surgery department meeting patients with cN0 phase,diagnosed as PTC and undergoing prophylactic central lymph node dissection.The control group with complications was 200 patients with PTC who did not undergo p-CND in the same period.2.Statistical analysis with SPSS,associated risk factors include age,gender,primary tumor size,BMI,tumor location,multiple focal,whether for bilateral lesions,with and without capsular invasion,whether withr hashimoto's thyroiditis and nodular goiter,blood TSH level and Tg level.The single factor analysis was applied to the test of ?2,and Logistic regression model was used to analyze the multiple factors,and the comparison of postoperative complications were used to test of ?2 and calculate Odds ratio(OR).P<0.05 was considered to be statistically significant.Results:1.The rate of central lymph node metastasis was 41.6%(246/591)in cN0 phase PTC patients.2.The single factor analysis found that age<45 years old,male,primary tumor diameter>10mm,tumor located in the middle and lower pole or spondylolysis glands,capsular invasion and multifocal are related to CLNM,multi-factor analysis found that age<45 years old,male,primary tumor diameter>10mm,mass located in the lower pole or glands spondylolysis,capsular invasion are independent risk factors.3.Compared with patients who did not receive p-CND,the incidence of parathyroid function injury and recurrent laryngeal nerve injury in p-CND group was increased.We found that postoperative complications:parathyroid function injury was associated,with p-CND,postoperative hematoma and recurrent laryngeal nerve injury were not significantly correlated with p-CND.p-CND increases the risk of parathyroid function and recurrent laryngeal nerve injury.4.Prognostic evaluation:follow-up 12-36 months,median follow-up time was 25 months,and the disease-free survival period of the patients with p-CND was 99.32%.Conclusion:cNO PTC prone to occult central lymph node metastasis,we suggest that the patients of preoperative age<45 years old,male,primary tumor diameter >10mm,mass located in the lower pole or glands with spondylolysis,capsular invasion strengthening the radiographic imaging of central lymph node,suggestion of p-CND,anatomical range according to the imaging results.When cleaning the lymph node in central region should protect parathyroid and laryngeal recurrent nerve function,use the emerging technologies such as nano carbon and nerve monitor in order to reduce postoperative permanent hypocalcemia and the incidence of laryngeal recurrent nerve injury.