Correlation analysis of clinicopathological factors of lymph node metastasis of recurrent laryngeal nerve in thyroid carcinoma

doi:10.3877/cma.j.issn.1674-3946.2022.06.028

Abstract

Abstract:

Objective

To investigate the clinicopathological factors associated with lymph node metastasis in the recurrent laryngeal nerve entry area（RLNIZ）of thyroid cancer（TC），and to explain its clinical significance in central lymph node dissection.

Methods

The clinical data of 1，240 patients with papillary thyroid carcinoma（PTC）from August 2018 to October 2020 were retrospectively analyzed. Among them，370 patients with RLNIZ lymph nodes were confirmed by pathological diagnosis. According to the presence or absence of metastasis，they were divided into two groups：RLNIZ lymph node metastasis group（n=110）and RLNIZ lymph node non-metastasis group（n=260）. The measurement data were expressed as（

x ˉ

±s），and the count data were expressed as［n（%）］. The relationship between RLNIZ lymph node metastasis and clinicopathological factors was analyzed by univariate χ²test and multivariate Logistic regression analysis，with P<0.05 as the test standard.

Results

The detection rate of RLNIZ lymph nodes was 29.8%（370/1240），including 29.7%（110/370）in RLNIZ metastasis group and 70.3%（260/370）in RLNIZ non-metastasis group. The average number of detected lymph nodes was（1.45±0.9）. BRAF^600VE mutation（P=0.018），Hashimoto（P=0.049），prelaryngeal（P=0.017）and lateral neck （P<0.001）lymph node metastasis were independent risk factors for RLNIZ metastasis.

Conclusion

In central dissection of thyroid cancer，attention should be paid to RLNIZ lymph node dissection to avoid late recurrence caused by omission.

Key words: Thyroid neoplasms, Recurrent laryngeal nerve inlet zone, Central lymph node, Lymph node metastasis

Xiaoqing Yang, Jie Xu, Guibin Zheng, Zhengzhai Wang, Xiyuan Lin, Haitao Zheng. Correlation analysis of clinicopathological factors of lymph node metastasis of recurrent laryngeal nerve in thyroid carcinoma[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2022, 16(06): 692-695.

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References 28

[1]	James BC，Mitchell JM，Jeon HD，et al. An update in international trends in incidence rates of thyroid cancer，1973-2007［J］. Cancer Causes Control，2018，29（4-5）：465-473.
[2]	Aydin Buyruk B，Kebapci N，Yorulmaz G，et al. An evaluation of clinicopathological factors effective in the development of central and lateral lymph node metastasis in papillary thyroid cancer［J］. J Natl Med Assoc，2018，110（4）：384-390.
[3]	Xing M，Alzahrani AS，Carson KA，et al. Association between BRAF V600E mutation and mortality in patients with papillary thyroid cancer［J］. JAMA，2013，309（14）：1493-1501.
[4]	Zhang TT，Qi XZ，Chen JP，et al. The association between tumor’s location and cervical lymph nodes metastasis in papillary thyroid cancer［J］. Gland Surg，2019，8（5）：557-568.
[5]	American Thyroid Association（ATA）Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer，Cooper David S，Doherty GM，et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer［J］. Thyroid，2009，19（11）：1167-1214.
[6]	Wada N，Duh QY，Sugino K，et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas：frequency，pattern of occurrence and recurrence，and optimal strategy for neck dissection［J］. Ann Surg，2003，237（3）：399-407.
[7]	Jiang LH，Yin KX，Wen QL，et al. Predictive Risk-scoring Model For Central Lymph Node Metastasis and Predictors of Recurrence in Papillary Thyroid Carcinoma［J］. Sci Rep，2020，10（1）：710.
[8]	廖有祥，汤恢焕，谭兴国，等. 分化型甲状腺癌73例再手术的临床分析［J］. 中国普通外科杂志，2006，15（4）：310-311.
[9]	郑桂彬，孙海清，吴国长，等. 甲状腺乳头状癌喉返神经入喉处淋巴结清扫的临床意义［J］. 中华普通外科杂志，2020，35（9）：709-712.
[10]	Song JY，Sun SR，Dong F，et al. Predictive Value of BRAF（V600E）Mutation for Lymph Node Metastasis in Papillary Thyroid Cancer：A Meta-analysis［J］. Current Medical Science，2018，38（5）：785-797.
[11]	Liu C，Chen T，Liu Z. Associations between BRAF（V600E）and prognostic factors and poor outcomes in papillary thyroid carcinoma：a meta-analysis［J］. World J Surg Oncol，2016，14（1）：241.
[12]	钟巧囡，林喜娜，奚少彦，等. 甲状腺乳头状癌中BRAF~（V600E）突变蛋白表达的意义［J］. 循证医学，2019，19（6）：349-352.
[13]	Xu X，Quiros RM，Gattuso P，et al. High prevalence of BRAF gene mutation in papillary thyroid carcinomas and thyroid tumor cell lines［J］. Cancer Res，2003，63（15）：4561-4567.
[14]	Ritterhouse LL，Barletta JA. BRAF V600E mutation-specific antibody：A review［J］. Semin Diagn Pathol，2015，32（5）：400-408.
[15]	Fraser S，Go C，Aniss A，et al. BRAF（V600E）Mutation is Associated with Decreased Disease-Free Survival in Papillary Thyroid Cancer［J］. World J Surg，2016，40（7）：1618-1624.
[16]	Zhang Q，Liu SZ，Zhang Q，et al. Meta-Analyses of Association Between BRAF（V600E）Mutation and Clinicopathological Features of Papillary Thyroid Carcinoma［J］. Cell Physiol Biochem，2016，38（2）：763-776.
[17]	Ma B，Wang Y，Yang S，et al. Predictive factors for central lymph node metastasis in patients with cN0 papillary thyroid carcinoma：A systematic review and meta-analysis［J］. Int J Surg，2016，28：153-161.
[18]	Qu HJ，Qu XY，Hu Z，et al. The synergic effect of BRAF（V600E）mutation and multifocality on central lymph node metastasis in unilateral papillary thyroid carcinoma［J］. Endocr J，2018，65（1）：113-120.
[19]	Aydoğan Bİ，Mutlu ABB，Yüksel S，et al. The Association of Histologically Proven Chronic Lymphocytic Thyroiditis with Clinicopathological Features，Lymph Node Metastasis，and Recurrence Rates of Differentiated Thyroid Cancer［J］. Endocr Pathol，2021，32（2）：280-287.
[20]	Dvorkin S，Robenshtok E，Hirsch D，et al. Differentiated thyroid cancer is associated with less aggressive disease and better outcome in patients with coexisting Hashimotos thyroiditis［J］. Clin Endocrinol Metab，2013，98（6）：2409-2414.
[21]	Lee I，Kim HK，Soh EY，et al. The Association Between Chronic Lymphocytic Thyroiditis and the Progress of Papillary Thyroid Cancer［J］. World J Surg，2020，44（5）：1506-1513.
[22]	Babli S，Payne RJ，Mitmaker E，et al. Effects of Chronic Lymphocytic Thyroiditis on the Clinicopathological Features of Papillary Thyroid Cancer［J］. Eur Thyroid，2018，7（2）：95-101.
[23]	Wang L，Chen J，Yuan X，et al. Lymph node metastasis of papillary thyroid carcinoma in the context of Hashimoto’s thyroiditis［J］. BMC Endocr Disord，2022，22（1）：12.
[24]	Liu Y，Lv H，Zhang S，et al. The Impact of Coexistent Hashimoto’s Thyroiditis on Central Compartment Lymph Node Metastasis in Papillary Thyroid Carcinoma［J］. Front Endocrinol，2021，12：772071.
[25]	郑桂彬，郝少龙，刘新承，等. Delphian淋巴结转移在甲状腺乳头状癌中的临床意义［J］. 中华耳鼻咽喉头颈外科杂志，2016，51（11）：842-845.
[26]	Kim DH，Kim SW，Hwang SH. Predictive Value of Delphian Lymph Node Metastasis in the Thyroid Cancer［J］. Laryngoscope，2021，131（9）：1990-1996.
[27]	闫云飞，刘娜，叶贝贝，等. 喉前淋巴结与甲状腺乳头状癌颈部淋巴结转移的相关性研究［J］. 天津医科大学学报，2021，27（4）：369-373.
[28]	吕恬，王琳，应夏洋，等. 喉返神经入喉处淋巴结对于甲状腺乳头状癌中央区淋巴结清扫的重要性［J］.外科理论与实践，2018，23（1）：52-56.

临床因素	类别	RLNIZ淋巴结(-) (n=260)	RLNIZ淋巴结(+) (n=110)	χ²	P
年龄	<45	102(59.0)	71(41.0)	19.898	<0.001
年龄	≥45	158(80.2)	39(19.8)
性别	男	70(62.5)	42(37.5)	4.642	0.031
性别	女	190(73.6)	68(26.4)
被膜侵犯	是	128(66.3)	65(33.7)	3.312	0.083
被膜侵犯	否	132(74.6)	45(25.4)
BRAF^VE600突变	是	51(57.3)	38(42.7)	9.476	0.009
	否	125(74.9)	42(25.1)
	未测	84(73.7)	30(26.3)
肿瘤最大径（㎝）	≥1	105(64.4）	58(35.6)	4.778	0.029
肿瘤最大径（㎝）	<1	155(74.9)	52(25.1)
桥本甲状腺炎	是	78(78.0)	22(22.0)	3.919	0.048
桥本甲状腺炎	否	182(67.4)	88(32.6)
肿瘤位置	上1/3	81(65.3)	43(34.7)	2.185	0.139
肿瘤位置	中下2/3	179(72.8)	67(27.2)
病灶数目	单发	166(69.2)	74(30.8)	0.398	0.528
病灶数目	多发	94(72.3)	36(27.7)
RLNIZ淋巴结位置	左	134(66.3)	68(33.7)	3.659	0.061
RLNIZ淋巴结位置	右	126(75.0)	42(25.0)
侧颈淋巴结转移	是	20(30.8)	45(69.2)	58.894	<0.001
侧颈淋巴结转移	否	240(78.7)	65(21.3)
喉前淋巴结转移	是	25(39.7)	38(60.3)	34.004	<0.001
喉前淋巴结转移	否	235(76.5)	72(23.5)
气管前淋巴结转移	是	72(54.1)	61(45.9)	25.875	<0.001
气管前淋巴结转移	否	188(79.3)	49(20.7)

临床因素	类别	RLNIZ淋巴结(-) (n=260)	RLNIZ淋巴结(+) (n=110)	χ²	P
年龄	<45	102(59.0)	71(41.0)	19.898	<0.001
年龄	≥45	158(80.2)	39(19.8)
性别	男	70(62.5)	42(37.5)	4.642	0.031
性别	女	190(73.6)	68(26.4)
被膜侵犯	是	128(66.3)	65(33.7)	3.312	0.083
被膜侵犯	否	132(74.6)	45(25.4)
BRAF^VE600突变	是	51(57.3)	38(42.7)	9.476	0.009
	否	125(74.9)	42(25.1)
	未测	84(73.7)	30(26.3)
肿瘤最大径（㎝）	≥1	105(64.4）	58(35.6)	4.778	0.029
肿瘤最大径（㎝）	<1	155(74.9)	52(25.1)
桥本甲状腺炎	是	78(78.0)	22(22.0)	3.919	0.048
桥本甲状腺炎	否	182(67.4)	88(32.6)
肿瘤位置	上1/3	81(65.3)	43(34.7)	2.185	0.139
肿瘤位置	中下2/3	179(72.8)	67(27.2)
病灶数目	单发	166(69.2)	74(30.8)	0.398	0.528
病灶数目	多发	94(72.3)	36(27.7)
RLNIZ淋巴结位置	左	134(66.3)	68(33.7)	3.659	0.061
RLNIZ淋巴结位置	右	126(75.0)	42(25.0)
侧颈淋巴结转移	是	20(30.8)	45(69.2)	58.894	<0.001
侧颈淋巴结转移	否	240(78.7)	65(21.3)
喉前淋巴结转移	是	25(39.7)	38(60.3)	34.004	<0.001
喉前淋巴结转移	否	235(76.5)	72(23.5)
气管前淋巴结转移	是	72(54.1)	61(45.9)	25.875	<0.001
气管前淋巴结转移	否	188(79.3)	49(20.7)

相关因素	OR	95％CI	P
年龄	0.607	0.354-1.038	0.068
性别	0.996	0.558-1.778	0.989
BRAF^VE600突变	1.446	1.065-1.964	0.018
肿瘤最大径（㎝）	0.883	0.514-1.516	0.652
桥本甲状腺炎	1.714	1.002-2.934	0.049
侧颈淋巴结转移	0.123	0.068-0.222	<0.001
喉前淋巴结转移	2.215	1.154-4.250	0.017
气管前淋巴结转移	0.800	0.434-1.474	0.475

相关因素	OR	95％CI	P
年龄	0.607	0.354-1.038	0.068
性别	0.996	0.558-1.778	0.989
BRAF^VE600突变	1.446	1.065-1.964	0.018
肿瘤最大径（㎝）	0.883	0.514-1.516	0.652
桥本甲状腺炎	1.714	1.002-2.934	0.049
侧颈淋巴结转移	0.123	0.068-0.222	<0.001
喉前淋巴结转移	2.215	1.154-4.250	0.017
气管前淋巴结转移	0.800	0.434-1.474	0.475

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