淋巴结比率对甲状腺乳头状癌生存的影响。
Impact of lymph node ratio on survival in papillary thyroid cancer.
机构信息
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
出版信息
Ann Surg Oncol. 2013 Jun;20(6):1906-11. doi: 10.1245/s10434-012-2802-8. Epub 2012 Dec 23.
BACKGROUND
In papillary thyroid cancer, the role of lymph node dissection remains controversial, and staging systems consider metastatic lymph nodes as a binary entity. The purpose of this study was to determine a threshold lymph node ratio (LNR) that impacted disease-specific mortality (DSM).
METHODS
We utilized the surveillance, epidemiology, and end results (SEER) database to analyze adult patients who underwent thyroidectomy with lymph node dissection. A LNR (metastatic lymph nodes to total lymph nodes) was calculated after eliminating patients with less than three nodes collected. Kaplan-Meier estimates for DSM were plotted for LNRs and compared by the log rank test. The Cox proportional hazards model was used to evaluate LNR with other known clinical and pathologic determinants of prognosis.
RESULTS
A total of 10,955 cases contained data on lymph nodes. Median follow-up time was 25 months (range 0-59 months), and the mean LNR was 0.28 ± 0.37. After comparing Kaplan-Meier survival estimates and overall DSM rates, we found that a LNR ≥0.42 best divided those with lymph node metastasis based on DSM (p < 0.01). Those with a LNR ≥0.42 experienced a DSM rate of 1.72 % while those with a LNR <0.42 had a DSM rate of 0.65 % (p < 0.01). In addition, patients with a LNR ≥0.42 experienced a 77 % higher DSM rate compared to those with metastatic lymph nodes as a whole. When considered with other known determinants of prognosis, we found that LNR was strongly associated with DSM (hazard ratio 4.33, 95 % confidence interval 1.68-11.18, p < 0.01).
CONCLUSIONS
LNR is a strong determinant of DSM, and a threshold LNR of 0.42 can be used to risk-stratify patients with metastatic lymph nodes.
背景
在甲状腺乳头状癌中，淋巴结清扫的作用仍存在争议，分期系统将转移性淋巴结视为二元实体。本研究旨在确定影响特定疾病死亡率（DSM）的淋巴结比率（LNR）阈值。
方法
我们利用监测、流行病学和最终结果（SEER）数据库分析了接受甲状腺切除术和淋巴结清扫术的成年患者。在消除了收集淋巴结数少于 3 个的患者后，计算了转移性淋巴结与总淋巴结的 LNR。绘制了 LNR 与 DSM 的 Kaplan-Meier 估计值图，并通过对数秩检验进行比较。使用 Cox 比例风险模型评估 LNR 与其他已知的临床和病理预后决定因素。
结果
共有 10955 例患者的数据包含淋巴结信息。中位随访时间为 25 个月（范围 0-59 个月），平均 LNR 为 0.28±0.37。比较 Kaplan-Meier 生存估计值和总体 DSM 率后，我们发现，基于 DSM，LNR≥0.42 最佳地将那些有淋巴结转移的患者分开（p<0.01）。LNR≥0.42 的患者 DSM 发生率为 1.72%，而 LNR<0.42 的患者 DSM 发生率为 0.65%（p<0.01）。此外，LNR≥0.42 的患者与所有转移性淋巴结患者相比，DSM 发生率高 77%。当与其他已知的预后决定因素一起考虑时，我们发现 LNR 与 DSM 密切相关（风险比 4.33，95%置信区间 1.68-11.18，p<0.01）。
结论
LNR 是 DSM 的一个重要决定因素，LNR 的阈值为 0.42 可用于对有转移性淋巴结的患者进行风险分层。
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