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Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study
INTRODUCTION: To assess the risk factor for the central lymph node (CLN) metastasis and investigated the surgery extent of lymph node dissection for patients with isthmic PTC (papillary thyroid carcinoma). MATERIALS AND METHODS: A total of 669 patients with a single nodule of isthmic PTC were retros...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Frontiers Media S.A.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240638/ https://www.ncbi.nlm.nih.gov/pubmed/34211434 http://dx.doi.org/10.3389/fendo.2021.620147 |
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author | Shuai, Yanjie Yue, Kai Duan, Yuansheng Zhou, Mengqian Fang, Yan Liu, Jin Liu, Dandan Jing, Chao Wu, Yansheng Wang, Xudong |
author_facet | Shuai, Yanjie Yue, Kai Duan, Yuansheng Zhou, Mengqian Fang, Yan Liu, Jin Liu, Dandan Jing, Chao Wu, Yansheng Wang, Xudong |
author_sort | Shuai, Yanjie |
collection | PubMed |
description | INTRODUCTION: To assess the risk factor for the central lymph node (CLN) metastasis and investigated the surgery extent of lymph node dissection for patients with isthmic PTC (papillary thyroid carcinoma). MATERIALS AND METHODS: A total of 669 patients with a single nodule of isthmic PTC were retrospectively reviewed. The propensity score matching was performed twice separately. 176 patients respectively from patients who underwent thyroidectomy plus bilateral central lymph node dissection (BCLND) and who underwent thyroidectomy plus unilateral central lymph node dissection (UCLND) were matched. 77 patients were respectively selected from patients who underwent thyroidectomy plus BCLND and who underwent thyroidectomy with no central lymph node dissection (NCLND) were matched. RESULTS: Among all the patients who underwent BCLND, 81/177 (45.76%) was confirmed with histologically positive CLN metastasis, and the occult lymph node metastasis is 25.42%. A tumor size of 1.05 cm was calculated as the cutoff point for predicting CLN metastasis by ROC curve analysis with 177 patients who underwent BCLND. The 5-year recurrence-free survival (RFS) rates were 92.9% in the NCLND group and 100% in the BCLND group with P<0.05, while there was no statistical difference in 5-year RFS between the BCLND group and UCLND group (P=0.11). The multivariate logistic regression analysis identified that age<55, tumor size>1cm, capsule invasion and lymphovascular invasion were significantly associated with CLN metastasis, while only age and lymphovascular invasion were proved to be independent risk factors related to contralateral CLN metastasis. CONCLUSIONS: The thyroidectomy with NCLND could be insufficient for patients with isthmic PTC especially for those patients with high risk of central lymph node metastasis, considering that the rate of occult lymph node metastasis could not be ignored. |
format | Online Article Text |
id | pubmed-8240638 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-82406382021-06-30 Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study Shuai, Yanjie Yue, Kai Duan, Yuansheng Zhou, Mengqian Fang, Yan Liu, Jin Liu, Dandan Jing, Chao Wu, Yansheng Wang, Xudong Front Endocrinol (Lausanne) Endocrinology INTRODUCTION: To assess the risk factor for the central lymph node (CLN) metastasis and investigated the surgery extent of lymph node dissection for patients with isthmic PTC (papillary thyroid carcinoma). MATERIALS AND METHODS: A total of 669 patients with a single nodule of isthmic PTC were retrospectively reviewed. The propensity score matching was performed twice separately. 176 patients respectively from patients who underwent thyroidectomy plus bilateral central lymph node dissection (BCLND) and who underwent thyroidectomy plus unilateral central lymph node dissection (UCLND) were matched. 77 patients were respectively selected from patients who underwent thyroidectomy plus BCLND and who underwent thyroidectomy with no central lymph node dissection (NCLND) were matched. RESULTS: Among all the patients who underwent BCLND, 81/177 (45.76%) was confirmed with histologically positive CLN metastasis, and the occult lymph node metastasis is 25.42%. A tumor size of 1.05 cm was calculated as the cutoff point for predicting CLN metastasis by ROC curve analysis with 177 patients who underwent BCLND. The 5-year recurrence-free survival (RFS) rates were 92.9% in the NCLND group and 100% in the BCLND group with P<0.05, while there was no statistical difference in 5-year RFS between the BCLND group and UCLND group (P=0.11). The multivariate logistic regression analysis identified that age<55, tumor size>1cm, capsule invasion and lymphovascular invasion were significantly associated with CLN metastasis, while only age and lymphovascular invasion were proved to be independent risk factors related to contralateral CLN metastasis. CONCLUSIONS: The thyroidectomy with NCLND could be insufficient for patients with isthmic PTC especially for those patients with high risk of central lymph node metastasis, considering that the rate of occult lymph node metastasis could not be ignored. Frontiers Media S.A. 2021-06-15 /pmc/articles/PMC8240638/ /pubmed/34211434 http://dx.doi.org/10.3389/fendo.2021.620147 Text en Copyright © 2021 Shuai, Yue, Duan, Zhou, Fang, Liu, Liu, Jing, Wu and Wang https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Endocrinology Shuai, Yanjie Yue, Kai Duan, Yuansheng Zhou, Mengqian Fang, Yan Liu, Jin Liu, Dandan Jing, Chao Wu, Yansheng Wang, Xudong Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study |
title | Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study |
title_full | Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study |
title_fullStr | Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study |
title_full_unstemmed | Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study |
title_short | Surgical Extent of Central Lymph Node Dissection for Papillary Thyroid Carcinoma Located in the Isthmus: A Propensity Scoring Matched Study |
title_sort | surgical extent of central lymph node dissection for papillary thyroid carcinoma located in the isthmus: a propensity scoring matched study |
topic | Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240638/ https://www.ncbi.nlm.nih.gov/pubmed/34211434 http://dx.doi.org/10.3389/fendo.2021.620147 |
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