Impact of Routine Unilateral Central Neck Dissection on Preablative and Postablative Stimulated Thyroglobulin Levels after Total Thyroidectomy in Papillary Thyroid Carcinoma

被引:82
作者
Lang, Brian Hung-Hin [1 ]
Wong, Kai Pun [1 ]
Wan, Koon Yat [2 ]
Lo, Chung Yau [1 ]
机构
[1] Univ Hong Kong, Dept Surg, Hong Kong, Hong Kong, Peoples R China
[2] Univ Hong Kong, Dept Clin Oncol, Hong Kong, Hong Kong, Peoples R China
关键词
LYMPH-NODE DISSECTION; RADIOIODINE TREATMENT; FOLLOW-UP; CANCER; METASTASES; ABLATION; RISK;
D O I
10.1245/s10434-011-1833-x
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Prophylactic central neck dissection (CND) remains controversial in papillary thyroid carcinoma (PTC). Because postsurgical stimulated thyroglobulin (sTg) level is a good surrogate for recurrence, the study aimed to evaluate the impact of prophylactic CND on preablative and postablative sTg levels after total thyroidectomy. Of the 185 patients retrospectively analyzed, 82 (44.3%) underwent a total thyroidectomy and prophylactic CND (CND-positive group) while 103 (55.7%) underwent total thyroidectomy only (CND-negative group). All patients had no preoperative or intraoperative evidence of lymph node metastases. Clinicopathological characteristics, postoperative outcomes, and preablative and postablative sTg levels were compared between the two groups. Preablative sTg level was taken at the time of radioiodine ablation, while postablative sTg level was taken 6 months after ablation. A multivariable analysis was conducted to identify factors for preablative athyroglobulinemia (sTg < 0.5 mu g/L). Relative to the CND-negative group, the CND-positive group had larger tumors (15 mm vs. 10 mm, P < 0.005), more extrathyroidal extension (26.8% vs. 14.6%, P < 0.003), more tumor, node, metastasis system stage III disease (32.9% vs. 9.7%, P < 0.001), and more temporary hypoparathyroidism (18.3% vs. 8.7%, P = 0.017). Fourteen patients (17.1%) in the CND-positive group were upstaged from stages I/II to III as a result of prophylactic CND. The CND-positive group experienced lower median preablative sTg (< 0.5 mu g/L vs. 6.7 mu g/L, P < 0.001) and a higher rate of preablative athyroglobulinemia (51.2% vs. 22.3%, P = 0.024), but these differences were not observed 6 months after ablation. Prophylactic CND was the only independent factor for preablative athyroglobulinemia. Although performing prophylactic CND in total thyroidectomy may offer a more complete initial tumor resection than total thyroidectomy alone by minimizing any residual microscopic disease, such a difference becomes less noticeable 6 months after ablation.
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收藏
页码:60 / 67
页数:8
相关论文
共 28 条
[1]  
[Anonymous], 1983, CANC INC MORT HONG K
[2]   Prophylactic Lymph Node Dissection for Papillary Thyroid Cancer Less Than 2 cm: Implications for Radioiodine Treatment [J].
Bonnet, Stephane ;
Hartl, Dana ;
Leboulleux, Sophie ;
Baudin, Eric ;
Lumbroso, Jean D. ;
Al Ghuzlan, Abir ;
Chami, Linda ;
Schlumberger, Martin ;
Travagli, Jean Paul .
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM, 2009, 94 (04) :1162-1167
[3]   Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer [J].
Carling, Tobias ;
Long, William D., III ;
Udelsman, Robert .
CURRENT OPINION IN ONCOLOGY, 2010, 22 (01) :30-34
[4]   The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk [J].
Chan, Wai-Fan ;
Lang, Brian Hung-Hin ;
Lo, Chung-Yau .
SURGERY, 2006, 140 (06) :866-872
[5]   Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer [J].
Cooper, David S. ;
Doherty, Gerard M. ;
Haugen, Bryan R. ;
Kloos, Richard T. ;
Lee, Stephanie L. ;
Mandel, Susan J. ;
Mazzaferri, Ernest L. ;
McIver, Bryan ;
Pacini, Furio ;
Schlumberger, Martin ;
Sherman, Steven I. ;
Steward, David L. ;
Tuttle, R. Michael .
THYROID, 2009, 19 (11) :1167-1214
[6]   Central Compartment Dissection in Thyroid Papillary Carcinoma [J].
Forest, Veronique-Isabelle ;
Clark, Jonathan R. ;
Ebrahimi, Ardalan ;
Cho, Eun-Ae ;
Sneddon, Lorna ;
Gao, Kan ;
O'Brien, Chris J. .
ANNALS OF SURGERY, 2011, 253 (01) :123-130
[7]   Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma [J].
Giovanella, Luca ;
Ceriani, Luca ;
Suriano, Sergio ;
Ghelfo, Antonella ;
Maffioli, Marco .
CLINICAL ENDOCRINOLOGY, 2008, 69 (04) :659-663
[8]   Serum thyroglobulin concentrations predict disease-free remission and death in differentiated thyroid carcinoma [J].
Heemstra, Karen A. ;
Liu, Ying Y. ;
Stokkel, Marcel ;
Kievit, Job ;
Corssmit, Eleonora ;
Pereira, Alberto M. ;
Romijn, Johannes A. ;
Smit, Johannes W. A. .
CLINICAL ENDOCRINOLOGY, 2007, 66 (01) :58-64
[9]   Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer [J].
Hughes, David T. ;
White, Matthew L. ;
Miller, Barbra S. ;
Gauger, Paul G. ;
Burney, Richard E. ;
Doherty, Gerard M. .
SURGERY, 2010, 148 (06) :1100-1106
[10]   Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid [J].
Ito, Y ;
Tomoda, C ;
Uruno, T ;
Takamura, Y ;
Miya, A ;
Kobayashi, K ;
Matsuzuka, F ;
Kuma, K ;
Miyauchi, A .
WORLD JOURNAL OF SURGERY, 2006, 30 (01) :91-99