The Clinical Studies And Meta-analysis Of Hierarchical Individualized Treatment With Cervical Lymph Nodes And Selective Prevention Calcium Supplement For Differentiated Thyroid Cancer

In surgical treatment of differentiated thyroid carcinoma (Differentiatedthyroid carcinoma, DTC), there are many disputes, especially in the treatmentof cervical lymph node indications. This study use the concept of hierarchicalindividualized therapy as starting.Discussing the security and applicationindications of central neck dissection(CND),and the postoperative changes inserum calcium and how to realize the selective prevention calciumsupplement.Research launched from three aspects above.1Meta-Analysis to Clinic Significance of differentiated thyroid carcinomawith central neck dissectionObjective：To compare the difference between recurrence rate and surgicalcomplications by thyroidectomy only or thyroidectomy combined with CND asinitial treatment to DTC. To evaluate the safety of DTC. Methods： Theliteratures published between1998-2013were searched in Wanfang database,Pubmed and so on.30articles were included according to the inclusion anddeletion criteria. Involving26articles in complications, the two majorcomplications: hypocalcemia and recurrent laryngeal nerve palsy were26articles and24articles,26articles in recurrence rate.RevMan5.0softwarepackage was used to perform meta-analysis. Results：In the studies for wholecomplication rates, the rates in experimental group(plus CND) is13.08%higherthan control group(thyroidectomy only), the odds ratio (OR) and their95%confidence interval (95%CI) was2.32[2.02，2.67], Z value was11.80, P <0.01. Hypocalcemia in the experimental group is11.80%higher than control group,OR values and their95%CI was2.58[2.21，3.02], Z was11.98, P <0.01.Recurrent laryngeal nerve paralysis is low.Not only in experimental group butalso in control group, the rates is5.26%and3.95%,and experimental group alittle higher1.31%. OR values and their95%CI was1.22[0.94，1.58], Z was1.48, P=0.14. For recurrence rates, the rates in experimental group is2.23%lower than control group, OR values and their95%CI was0.78[0.63，0.97], Zwas2.35, P=0.03. Conclusion：CND may reduce the risk of recurrence asinitial treatment to DTC, but also it may increases the incidence of totalcomplications and hypocalcemia, however recurrent laryngeal nerve paralysishad been no significant effect. 2Clinicopathological features of differentiated thyroid carcinoma thatguidance on treatment of cervical lymph nodesObjective:To investigate the relationship between tumor location, size,infiltration of the thyroid capsule and other clinicopathological features withdifferentiated thyroid carcinoma lymph node metastasis. Methods： Aretrospective analysis from July2010to July2013Head and Neck Surgery,Sichuan Cancer Hospital admitted to initial surgical treatment of248patientswith clinical and pathological data. Results：Tumor location, size, quantity，infiltration beyond the outer membrane gland,involvement with several glandsand so on were related to level VI and II-V lymph node status; Younger age only with VI lymph node metastasis.When the tumor was located in the lowerpole, VI district metastasis rates was up to74.29%, II-V area were just45.00%,and when the tumor was located in the upper pole, VI district metastasis rateswas58.33%, II-V regions were as high as84.21%. Tumor diameter greaterthan1cm and2cm were central and lateral neck metastasis rates risingthreshold. Conclusion：These features: mass in the lower pole, diameter>1cm,multiple, multi-leaf involvement, leaching capsule, younger can be used ascentral lymph node metastasis risk factors;While the mass in the upper pole,diameter greater than2cm, multiple, multi-leaf involvement, leaching capsulemay be lateral neck lymph node metastasis risk factors; We should payparticular attention to the relationship between tumor location and differentregions of lymph node status and when tumor volume as risk factors forregional lymph node metastasis, its critical value is different 3To discuss the postoperative changes in serum calcium and the selectiveprevention calcium supplement for differentiated thyroid carcinoma withcentral neck dissectionObjective: To investigate the incidence of postoperative hypocalcemia calcium and survey dynamic changes after CND at initial treatment of DTC.To seek the selective prevention calcium supplement strategies. Methods:A prospectively study was carried out with132patients who were treated from March2012to March2014. According to the inclusion criteria, patients were divided into four groups,Group A is low-risk group,only use PT; Group B、C and D are high-risk groups, they adopt TT+CND;Group C was given oral rehydration calcium after operation；group D was given intravenous calcium intervention.The calcium and parathyroid hormone levels with dynamic monitoring in each group when1-3days,4-7days and more than7days after operation.While the incidence of hypocalcemia in each group put to use counting statistics.Results: The blood calcium of patients from four groups were decreased for different degrees firstly and gradually recover after operation,The decreased in1-3days wasmost obvious,Group B was lowest with2.02±0.15,D group was highestto2.18±0.16and higher than group A at2.15±0.17,Group C was2.03±0.16.All groups can be restored to normal levels one week later.After repeated measures analysis of variance showed: F=147.45, P <0.05,The differences between the groups statistically significant.Monitoring parathyroidhormone display that:Group A was significantly higher than group B、C、D all the time. The PTH of group C(18.57±9.18)and D (19.97±9.14)weresignificantly decreased after1-3days,Group B was23.13±18.95,the test:F=120.45,P <0.05,significant differences exist between the groups.Each group appearred postoperative hypocalcemia.Group B was obvious,accounting for73.3%of asymptomatic and symptomatic accounted for40.0%. Group C and D have eased, with the highest remission rate in group D, Group A with the lowest occurrence rate was:45.5%and6.1%,X2values were:X2=18.601,P <0.001and X2=12.865,P=0.005.Conclusion: To recommend selective prevention calcium supplement for DTC based on risk stratification.Low-risk group that only use PT may be considered observation first. High-risk group that put TT with CND can be started prophylactic calcium supplement on the1st day postoperative.Intravenous supplement with2g daily to a week after surgery is appropriate.If use oral calcium supplementation,the dose should be at least higher than30ml per day and the application period should be more than one week.