| ObjectiveA retrospective and systematic study was conducted to investigate the relationship between the clinical pathological characteristics and clinical prognosis of postoperative metastatic lymph nodes in patients with differentiated thyroid cancer(DTC).The optimal threshold for risk recurrence stratification was redefined based on the size of lymph node metastasis focus,and the size of lymph node metastasis focus was combined with pre-activated thyroglobulin(ps-Tg),Used to jointly predict the disease-free survival period of DTC patients after receiving radioactive iodine therapy,identify their risk factors,and manage patients with medium to high risk factors in a targeted manner,assisting clinical physicians in developing appropriate treatment plans.Materials and methodsRetrospective analysis was made on DTC patients who received total/near total resection of thyroid cancer and neck lymph node dissection,and who were treated with radioactive iodine for the first time in the nuclear medicine department of Zhujiang Hospital Hospital of Southern Medical University from July 2014 to June 2017.Collect demography characteristics,clinical data and pathological data of DTC patients.If any of the following conditions are met,it can be ruled out:(1)DTC patients find distant metastasis during surgery or the first radioactive iodine treatment;(2)The size of lymph node metastasis focus or pathological data in DTC patients are incomplete;(3)DTC patients have previously received radioactive iodine therapy in other hospitals;(4)Anti-thyroid autoantibodies(TgAb)in DTC patients were positive(>115 IU/mL);(5)The follow-up time for DTC patients after the first radioactive iodine treatment is less than 24 months.ResultA total of 543 DTC patients were included in this study,with a median follow-up time of 62 months and a final outcome of 414 Cases(76.2%)of DTC patients have good clinical prognosis.Analysis found that the four clinical pathological features of metastatic lymph node cancer,including the size of lymph node metastasis focus,the number of metastatic lymph nodes,lymph node ratio(LNR),and extranodal extension(ENE),are significantly correlated with clinical prognosis,while the clinical pathological feature of skip metastasis is not significantly correlated with clinical prognosis.In multivariate analysis,the size of lymph node metastasis focus,ps-Tg,and total dose of radioactive iodine therapy are independent predictors of long-term remission in DTC patients.The size of lymph node metastasis focus ranging from 0.4 cm to 1.4 cm(medium risk)and>1.4 cm(high risk)increased the risk of recurrence in DTC patients(HR[95%CI],4.674[2.881-7.583]and 13.653[8.35-22.913],respectively).The inclusion of ps-Tg in the size of lymph node metastasis focus suggests that ps-Tg≤10.1 ng/mL is associated with better long-term response rates(low risk patients increased from 92.2%to 95.4%,medium risk patients increased from 67.3%to 87.0%,and high-risk patients increased from 32.3%to 57.7%).ConclusionA correct understanding of the relationship between the clinical pathological characteristics of metastatic lymph nodes and clinical prognosis is beneficial for the treatment and management of DTC patients.Redefining the critical values for recurrence risk stratification based on the maximum diameter of metastatic lymph node cancer lesions as 0.4 cm and 1.4 cm,respectively,combined with ps-Tg,can more effectively predict clinical outcomes,assist clinicians in formulating appropriate treatment plans,extend progression disease-free survival,and improve prognosis. |
PDF Full Text Request