Incidence of Delphian lymph node metastasis in unilateral papillary thyroid carcinoma and clinical significance

Abstract

Abstract:ObjectsTo study the incidence of Delphian lymph node (DLN) metastasis in patients with unilateral pa-pillary thyroid carcinoma (PTC) and the clinical significance.MethodsThe clinicopathological data of 522 patients with unilateral PTC in our hospital between January 2016 and December 2019 were analyzed retrospectively. The association between DLN metastasis and the clinicopathological characteristics including age, sex, tumor size, multifocality, capsular invasion, extrathyroidal extension, tumor location, central lymph node (CLN) metastasis (excluding DLN), and lateral lymph node metastasis was analyzed.ResultsOne hundred thirty-three(25.5%) of 522 patients had DLN metastasis. It was significant that DLN metastasis was associated with age (P=0.047), male (P<0.001), larger tumor size (P<0.001), capsular invasion (P<0.001), extrathyroidal extension (P=0.004), tumor location (P=0.003), CLN metastasis (P<0.001), number of positive CLN (excluding DLN) (P<0.001), lateral compartment lymph node (LLN) metastasis (P=0.036), number of positive LLN (P=0.004) and number of DLN removed (P=0.043).ConclusionsThe DLN metastasis was shown to be associated significantly with several factors of poor PTC prognosis. When the DLN of intraoperative frozen section is positive, careful dissection and evaluation of CLN and LLN are essential with necessary follow-up.

Key words:Delphian lymph node,Papillary thyroid cancer,Metastasis

CLC Number:

R736.1

LIU Wei, WANG Cong, WANG Zhenglin, AI Zhilong. Incidence of Delphian lymph node metastasis in unilateral papillary thyroid carcinoma and clinical significance[J]. Journal of Surgery Concepts & Practice, 2021, 26(05): 445-448.

Figures/Tables2

特征	DLN转移组(n=133)	DLN未转移组(n=389)	P值
年龄 (岁）	41.0±12.3	43.4±11.7	0.047^a）
女/男	64\69	261\128	<0.001^b）
肿瘤最大径（cm）	1.27±0.68	0.92±0.57	<0.001^a）
甲状腺包膜侵犯	84 (63.2)	177 (45.5)	<0.001^b）
甲状腺腺体外侵犯	18 (13.5)	21 (5.4)	0.004^b）
肿瘤多灶	22 (16.5)	58 (14.9)	0.676^b）
肿瘤位置			0.003^b）
上1\3	60 (45.1)	121 (31.1)
中1\3	35 (26.3)	160 (41.1)
下1\3	38 (28.6)	108 (27.8)
CLN*清扫术	133	389
CLN*中位数（四分位数）	5 (2~7)	4 (2~6)	0.140^c）
CLN*转移 (%)	108 (81.2)	161 (41.4)	<0.001^b）
CLN*转移中位数 (四分位数)	2 (1~4)	0 (0~2)	<0.001^c）
CLN*转移密度	0.65	0.16	<0.001^a）
LLN清扫术	30	16
LLN中位数 (四分位数)	21 (15~27)	20 (13.25~23.75)	0.267^c）
LLN转移	29 (96.7)	11 (68.8)	0.036^b）
LLN转移中位数 (四分位数)	4.5 (2.00~7.25)	1.5 (0.25~3.75)	0.004^c）
清扫DLN中位数 (四分位数)	2 (1~3)	2 (1~2)	0.043^c）

研究	时间（年）	纳入对象	DLN（+）	结果
Isaacs等^{[ 7 ]}	2008	87例PTC 16例髓样癌	22例	与肿瘤直径相关与年龄无关
Iyer等^{[ 8 ]}	2011	101例PTC	25例	与腺体外侵犯、CLN、LLN有关与年龄、肿瘤直径无关
Kim等^{[ 9 ]}	2012	308例PTC	53例	与肿瘤直径、多灶性、腺体外侵犯、LLN转移有关与年龄无关
Lee等^{[ 10 ]}	2013	67例PTC	13例	与肿瘤直径、、腺体外侵犯、CLN及LLN转移有关与年龄、性别、多灶性无关
Oh等^{[ 11 ]}	2013	245例PTC	49例	与性别、肿瘤直径、多灶性、CLN及LLN转移有关与年龄无关
Tan等^{[ 12 ]}	2017	231例PTC	19例	与肿瘤直径、腺体外侵犯、CLN及LLN转移有关与性别、多灶性无关
Zheng等^{[ 13 ]}	2017	206例PTC	42例	与肿瘤直径、多灶性、腺体外侵犯、CLN转移有关与性别无关

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