颈部淋巴结转移与甲状腺乳头状癌的治疗及预后.pdfVIP

国际内分泌代谢杂志2016 年7 月第36 卷第4 期 Int J Endocrinol Metab ,July 2016 ,Vol. 36 .No.4 .277 . ·综述· 颈部淋巴结转移与甲状腺乳头状癌的治疗及预后 党红转徐书杭王建华刘超 【摘要} 颈部淋巴结转移在甲状腺乳头状癌中较为普遍。尽管颈部淋巴结转移可独立预测甲 状腺乳头状癌的复发，但其对于肿瘤预后的影响仍有争议。预防性中央区淋巴结对甲状腺乳头状癌 患者的价值尚不清楚，尤其是术前元颈部淋巴结转移的临床或影像学证据时。对于存在危险因素的 甲状腺乳头状癌患者，如男性、年龄大于45 岁、肿瘤直径 4 cm、多灶性和甲状腺外侵犯以及BRAF基 因突变阳性等，术前应认真评估颈部淋巴结，必要时可行预防性中央区淋巴结清扫。 [关键词] 甲状腺乳头状癌;淋巴结;转移;预后 Treatment and pro伊osis of papillary thyroid cancer with cervical lymph node metastasis Dang Hongzhua旷 • Xu Shuhang , Wang Jianhua , Liu Chω. 事 Department 0/ Endocrinology , Hongze Hoψitalo/ Traditional Chinese Medicine , Huai an 223100 , China Corresponding αuthor: Xu Shuhang , Email: shuhangxu@163.com [Abstract] Lymph nodes metastasis in the neck is common in papill町thyroid cancer. Although the presence of lymph nodes metastasis is an independent predictor for recurrence , its si伊ificance is controver- sial and may have little prognostic significance. The role of prophylactic central neck dissection (pCND) for patients with papillary thyroid cancer is unclear , particularly when there are no clinical or radiological evi- dence of cervicallymph node metastasis. In patients who are deemed high risk including male sex , age 45 years , tumour diameter greater than 4 cm , extracapsular , extrathyroidal disease , or positive BRAF mutation , a comprehensive evaluation of cervical lymph node should be considered , and pCND may be performed if necess缸y. [ Key words] Papillary thyroid cancer; Lymph node; Metastasis; P吨nosls 临床评估可早期发现5%-10% 的PTC患者在术前即 甲状腺乳头状癌(PTC) 是最常见的甲状腺恶性 已有淋巴结转移，而颈部超声检查敏感性更高，可发 肿瘤，其分化程度高，生长缓慢，预后好，5 年生存率 现约30% 存在淋巴结转移。报道显示，359毛的PTC 超过90% 。尽管预后良好，但手术证实PTC患者淋