cN0级单侧甲状腺乳头状癌患者对侧气管旁淋巴结转移临床特征的Meta分析
Clinical characteristics for unilateral cN0 PTC patients who have contralateral paratracheal lymph node metastasis:A meta-analysis
朱毅凡 1洒娜 1赵婉君 1刘会 1徐伟 1吕正华1
作者信息
- 1. 山东省耳鼻喉医院耳鼻咽喉头颈外科,山东大学,山东 济南 250023
- 折叠
摘要
目的 分析临床淋巴结阴性(clinically node-negative,cN0)的单侧甲状腺乳头状癌(papillary thyroid cancer,PTC)患者发生对侧中央区淋巴结转移(contralateral central lymph node metastasis,CCLNM)临床危险因素,为预防性中央区淋巴结清扫(prophylactic central lymph node dissection,PCLND)的范围提供依据.方法 检索PubMed、Cochrane Library、Web of Science、EMBASE、CNKI数据库中公开发表研究cN0单侧PTC患者CCLNM临床特征的相关文献,截至时间为2023年9月,采用RevMan5.4、Stata15.1软件进行数据分析.结果 共纳入14篇文献,包括3 532例患者.所有患者CCLNM发生率范围为3.9%～30.6%.分析结果提示:男性(OR=1.65,95%CI=1.28～2.11)、肿瘤直径≥1 cm(OR=2.88,95%CI=2.30～3.60)、年龄≤55岁(OR=2.10,95%CI=1.15～3.82)、包膜受累(OR=1.63,95%CI=1.04～2.57)、腺外侵犯(OR=1.76,95%CI=1.31～2.36)、脉管侵犯(OR=4.23,95%CI=2.25～7.98)、同侧中央区淋巴结转移(OR=10.83,95%CI=5.56～21.10)、喉前淋巴结转移(OR=4.32,95%CI=2.66～7.02)、气管前淋巴结转移(OR=6.67,95%CI=2.06～21.54)患者更容易发生CCLNM(P均<0.05).而未发现肿瘤多灶性、桥本甲状腺炎、BRAF基因突变、MACIS≥6、超声回声、超声血流与CCLNM相关.结论 男性、肿瘤直径≥1 cm、年龄≤55岁、包膜受累、腺外侵犯、脉管侵犯、同侧中央区淋巴结转移、喉前淋巴结转移、气管前淋巴结转移是发生CCLNM的重要危险因素,这些因素可作为cN0单侧PTC患者PCLND的程度指标.
Abstract
OBJECTIVE To establish the range of prophylactic central lymph node dissection,this study evaluated the clinical characteristics of contralateral central lymph node metastasis(CCLNM)for patients with clinically node-negative unilateral papillary thyroid carcinoma.METHODS Related articles published in PubMed,Web of Science,Cochrane Library,Embase,and CNKI databases on the clinical characteristics of CCLNM in cN0 unilateral PTC were searched until September 2023.The data were analyzed using RevMan 5.4 and Stata 15.1 software.RESULTS Fourteen research studies with 3 532 individuals were included.The incidence of CCLNM in all patients ranged from 3.9%to 30.6%.Pooled analysis showed that male(pooled OR=1.65;95%CI=1.28-2.11),tumor size≥1 cm(pooled OR=2.88,95%CI=2.30-3.60),age≤55 years(pooled OR=2.10,95%CI=1.15-3.82),capsular invasion(pooled OR=1.63;95%CI=1.04-2.57),extrathyroidal extension(pooled OR=1.76,95%CI=1.31-2.36),lymphovascular invasion(pooled OR=4.23;95%CI=2.25-7.98),ipsilateral central lymph node metastasis(pooled OR=10.83,95%CI=5.56-21.10),pretracheal lymph node metastasis(pooled OR=6.67,95%CI=2.06-21.54),and prelaryngeal lymph node metastasis(OR=4.32;95%CI=2.66-7.02)patients were more likely to develop CCLNM(all P values<0.05).However,CCLNM was not associated with multifocal lesions,Hashimoto's thyroiditis,BRAF mutation,MACIS≥6,hypoechoic lesions,or vascularization of the lesion in ultrasonography.CONCLUSION Analysis revealed that male gender,tumor size≥1 cm,age≤55 years,capsular invasion,extrathyroidal extension,lymphovascular invasion,ipsilateral central lymph node metastasis,pretracheal lymph node metastasis,and prelaryngeal lymph node metastasis are the significant predictors for CCLNM.And these results can give guidance on the degree of prophylactic central lymph node dissection in cN0 unilateral PTC patients.
关键词
甲状腺肿瘤/危险因素/Meta分析(主题)/甲状腺癌,乳头状/淋巴结转移Key words
Thyroid Neoplasms/Risk Factors/Meta-Analysis as Topic/thyroid cancer,papillary/lymphatic metastasis引用本文复制引用
基金项目
海南省重大科技项目(ZDKJ202005)
出版年
2024
国家科技期刊平台
NSTL
维普
万方数据