预防性颈中央区淋巴结清扫对cN0期甲状腺乳头状癌疗效的Meta分析

doi:10.3760/cma.j.issn.2095-7041.2018.05.013

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摘要目的探讨预防性颈中央区淋巴结清扫术(PCND)在cN0期甲状腺乳头状癌(PTC)患者手术治疗中的临床应用价值。方法分别以“甲状腺乳头状癌、预防性颈中央区淋巴结清扫、复发、并发症”和“papillary thyroid carcinoma、prophylactic central neck dissection/prophylactic central cervical lymph node dissection、recurrence、complication”为中英文检索词,检索PubMed、EMbase、The Cochrane Library、CNKI、万方数据库、中国生物医学文献数据库,限定文献发表年限为2007—2017年,纳入比较单纯行甲状腺乳头状癌原发灶手术治疗(对照组)和同时加行预防性颈中央区淋巴结清扫(观察组)临床疗效的队列研究,由两名研究者独立筛选文献与提取数据,并进行质量评价。计数资料采用优势比(OR)及95%可信区间(CI)表示。采用I²进行异质性分析。结果共纳入符合筛选标准的文献10篇,均为回顾性队列研究,共3 383个研究对象,其中对照组1 797例,观察组1 586例。Meta分析结果显示:观察组与对照组局部复发率之间的差异无统计学意义(OR=0.97,95%CI 0.63～1.50, P=0.90)。与对照组相比,观察组术后暂时性低钙血症(OR=2.20,95%CI 1.81～2.68, P＜0.000 01)、永久性低钙血症(OR=3.02,95%CI 1.97～4.61,P＜0.000 01)、暂时性喉返神经损伤(OR=1.58,95%CI 1.06～2.34, P=0.02)、永久性喉返神经损伤(OR=1.90,95%CI 1.10～3.58, P=0.05)的发生率均增高,且差异均有统计学意义。结论对于cN0期PTC患者,在原发灶手术治疗的同时行PCND并不能降低肿瘤的局部复发率,但却能明显增加手术并发症风险;因此,不推荐临床常规实施该术式。

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	杨雨燕
	温树信
	王斌全
	高伟
	吴勇延
	张春明
	樊佳敏
	朱乔乔

关键词 ：甲状腺肿瘤, 甲状腺乳头状癌, 预防性颈中央区淋巴结清扫, 复发, 并发症, Meta分析

Abstract：Objective To explore the clinical value of prophylactic central cervical lymph node dissection(PCND) as initial treatment for the patients with cN0 papillary thyroid carcinoma(PTA).Methods Literatures were researched using PubMed, EMbase, The Cochrane Library, CNKI, Wanfang database and the Chinese Biomedical Literature Database from 2007 to 2017 with the key words including “papillary thyroid carcinoma, prophylactic central neck dissection/prophylactic central cervical lymph node dissection, recurrence, complication”. The cohort studies about comparison of clinical effects of thyroidectomy alone and thyroidectomy combined with prophylactic central cervical lymph node dissection were received and enrolled. Patients underwent papillary thyroid carcinoma using thyroidectomy alone and thyroidectomy combined with prophylactic central cervical lymph node dissection were respectively allocated into thyroidectomy group(control group) and thyroidectomy+prophylactic central neck dissection group(observation group). Two reviewers independently screened literatures, extracted data and assessed the risk of bias. Count data were described as odd ratio (OR) and 95% confidence interval (CI). The heterogeneity of the studies was analyzed using the I² test.Results After literature screening, 10 articles were selected, all of which were retrospective cohort study. A total of 3 383 subjects were enrolled, including 1 797 cases in control group and 1 586 cases in observation group. Meta-analysis showed that: there was no significant difference in the local recurrence rate between the two groups(OR=0.97, 95%CI 0.63-1.50, P=0.90). In observation group, the risks of temporary hypocalcemia (OR=2.20, 95%CI 1.81-2.68, P＜0.000 01), permanent hypocalcemia (OR=3.02, 95%CI 1.97-4.61, P＜0.000 01), temporary recurrent laryngeal nerve injury (OR=1.58, 95%CI 1.06-2.34, P=0.02), permanent recurrent laryngeal nerve injury (OR=1.90, 95%CI 1.10-3.58, P=0.05)were higher than those of control group, and the differences were statistically significant.Conclusionse PCND for the patients with cN0 PTA does not reduce the local recurrence rate, but significantly increases the risks of the complications.

Key words： Thyroid neoplasms Papillary thyroid carcinoma Trophylactic central neck dissection Recurrence Complications Meta analysis

收稿日期: 2018-05-15

通讯作者: 温树信, Email: wensxsx@163.com

引用本文:

杨雨燕, 温树信, 王斌全, 高伟, 吴勇延, 张春明, 樊佳敏, 朱乔乔. 预防性颈中央区淋巴结清扫对cN0期甲状腺乳头状癌疗效的Meta分析[J]. 中华解剖与临床杂志, 2018, 23(5): 422-427.
Yang Yuyan, Wen Shuxin,Wang Binquan, Gao Wei, Wu Yongyan, Zhang Chunming, Fan Jiamin, Zhu Qiaoqiao. The effect of prophylactic central cervical lymph node dissection on papillary thyroid carcinoma in cN0 stage: a Meta analysis. Chinese Journal of Anatomy and Clinics, 2018, 23(5): 422-427.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2018.05.013 或 http://www.cjac.com.cn/CN/Y2018/V23/I5/422

[1]	温树信, 王斌全, 皇甫辉, 等. 分化型甲状腺癌的特殊性与外科治疗争议[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(4): 302-304. DOI:10.3760/cma.j.issn.1673-0860.2017.04.016.
[2]	孙荣昊, 李超, 樊晋川, 等. 中央区淋巴清扫术对初治分化型甲状腺癌临床价值的Meta分析[J]. 中华耳鼻咽喉头颈外科杂志, 2014, 49(2): 157-164. DOI:10.3760/cma.j.issn.1673-0860.2014.02.014.
[3]	Liang J, Li Z, Fang F, et al. Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature[J]. Acta otorhinolaryngol Ital, 2017, 37(1): 1-8. DOI:10.14639/0392-100X-1195.
[4]	李宇杰, 黄小娥, 周小栋. 预防性中央区淋巴结清扫与甲状腺乳头状癌局部复发的Meta分析[J]. 中国普通外科杂志, 2013, 22(5): 608-612. DOI:10.7659/j.issn.1005-6947.2013.05.016.
[5]	Zetoune T, Keutgen X, Buitrago D, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis[J]. Ann Surg Oncol, 2010, 17(12): 3287-3293. DOI:10.1245/s10434-010-1137-6.
[6]	温树信, 王斌全. 分化型甲状腺癌的预防性颈中央区淋巴清扫术适应证探讨[J]. 中华耳鼻咽喉头颈外科杂志, 2011, 46(11): 952-953. DOI:10.3760/cma.j.issn.1673-0860.2011.11.022.
[7]	张彬. 国内分化型甲状腺癌外科规范化治疗的问题与对策[J]. 中华耳鼻咽喉头颈外科杂志, 2017, 52(4):241-244. DOI:10.3760/cma.j.issn.1673-0860.2017.04.001.
[8]	Barczyński M. Author's reply: prophylactic central neck dissection for papillary thyroid cancer (Br J Surg 2013; 100: 410-418)[J]. Br J Surg, 2013, 100(8): 1115. DOI:10.1002/bjs.9173.
[9]	Calò PG, Pisano G, Medas F, et al. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment?[J]. World J Surg Oncol, 2014, 12: 152. DOI:10.1186/1477-7819-12-152.
[10]	Calò PG, Conzo G, Raffaelli M, et al. Total thyroidectomy alone versus ipsilateral versus bilateral prophylactic central neck dissection in clinically node-negative differentiated thyroid carcinoma. A retrospective multicenter study[J]. Eur J Surg Oncol, 2017, 43(1): 126-132. DOI:10.1016/j.ejso.2016.09.017.
[11]	Costa S, Giugliano G, Santoro L, et al. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer[J]. Acta Otorhinolaryngol Ital, 2009, 29(2): 61-69.
[12]	Ywata de Carvalho A, Chulam TC, Kowalski LP. Long-term results of observation vs prophylactic selective level VI neck dissection for papillary thyroid carcinoma at a cancer center[J]. JAMA Otolaryngol Head Neck Surg, 2015, 141(7): 599-606. DOI:10.1001/jamaoto.2015.0786.
[13]	Dobrinja C, Troian M, Cipolat Mis T, et al. Rationality in prophylactic central neck dissection in clinically node-negative (cN0) papillary thyroid carcinoma: is there anything more to say? A decade experience in a single-center[J]. Int J Surg, 2017, 41(Suppl 1): S40-S47. DOI:10.1016/j.ijsu.2017.01.113.
[14]	Giordano D, Frasoldati A, Gabrielli E, et al. Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma[J]. Am J Otolaryngol, 2017, 38(5): 576-581. DOI:10.1016/j.amjoto.2017.06.004.
[15]	Lee DY, Oh KH, Cho JG, et al. The benefits and risks of prophylactic central neck dissection for papillary thyroid carcinoma: prospective cohort study[J]. Int J Endocrinol, 2015, 2015: 571480. DOI:10.1155/2015/571480.
[16]	Raffaelli M, De Crea C, Sessa L, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma[J]. Surgery, 2012, 152(6): 957-964. DOI:10.1016/j.surg.2012.08.053.
[17]	So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications[J]. Surgery, 2012, 151(2): 192-198. DOI:10.1016/j.surg.2011.02.004.
[18]	Liu J, Xu Z, Li Z, et al. Long-term outcomes of observation for clinically negative central compartment lymph nodes in papillary thyroid carcinoma[J]. Eur Arch Otorhinolaryngol, 2015, 272(12): 3801-3804. DOI:10.1007/s00405-014-3453-0.
[19]	Nixon IJ, Wang LY, Ganly I, et al. Outcomes for patients with papillary thyroid cancer who do not undergo prophylactic central neck dissection[J]. Br J Surg, 2016, 103(3): 218-225. DOI:10.1002/bjs.10036.
[20]	Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2016, 26(1): 1-133. DOI:10.1089/thy.2015.0020.
[21]	White ML, Gauger PG, Doherty GM. Central lymph node dissection in differentiated thyroid cancer[J]. World J Surg, 2007, 31(5): 895-904. DOI:10.1007/s00268-006-0907-6.
[22]	Bonnet S, Hartl D, Leboulleux S, et al. Prophylactic lymph node dissection for papillary thyroid cancer less than 2 cm: implications for radioiodine treatment[J]. J Clin Endocrinol Metabol, 2009,94(4): 1162-1167. DOI:10.1210/jc.2008-1931.
[23]	Chisholm EJ, Kulinskaya E, Tolley NS. Systematic review and meta-analysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone[J]. Laryngoscope, 2009, 119(6): 1135-1139. DOI:10.1002/lary.20236.