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| 題 名 | The Clinical Significance of Retropharyngeal/Parapharyngeal Lymph Node Metastasis in Papillary Thyroid Cancer: A Single-Center Observational Study=甲狀腺乳突癌中咽後/咽旁淋巴結轉移的臨床意義:單一中心觀察性研究 |
|---|---|
| 作 者 | 陳祖康; 張雁翔; | 書刊名 | Annals of Nuclear Medicine and Molecular Imaging |
| 卷 期 | 38:4 2025.12[民114.12] |
| 頁 次 | 頁119-129 |
| 分類號 | 415.662 |
| 關鍵詞 | 甲狀腺乳突癌; 咽後或咽旁區域; 淋巴結轉移; Lymph node metastasis; Papillary thyroid cancer; Retropharyngeal/parapharyngeal space; |
| 語 文 | 英文(English) |
| DOI | 10.6332/ANMMI.202512_38(4).0002 |
| 中文摘要 | 背景:淋巴結轉移在甲狀腺乳突癌中相當常見,約占 20%–50% 的患者。然 而,發生於咽後或咽旁的淋巴結轉移則相當罕見。本研究旨在評估甲狀腺乳 突癌中咽後或咽旁淋巴結轉移的臨床特徵與預後。 方法:本研究回溯性分析本院自 2008 年 7 月至 2022 年 6 月間 17 例具有咽 後或咽旁淋巴結轉移的甲狀腺乳突癌病例。根據病歷記錄,收集其臨床病理 與人口統計資料,包括年齡、性別、腫瘤大小、甲狀腺外侵犯、TNM 分期、 美國甲狀腺學會 (American Thyroid Association, ATA) 風險分類、甲狀腺球 蛋白濃度、放射性碘攝取情況、葡萄糖正子造影攝取情形及疾病進展時間。 無惡化存活期 (progression-free survival, PFS) 以 Kaplan-Meier 法進行統計 分析。 結果:17 位患者中有 9 位 (53%) 在初診斷時即被發現有咽後或咽旁淋巴結 轉移。確診時的年齡中位數為 57 歲(範圍:26–81 歲)。轉移性咽後或咽 旁淋巴結的最大徑中位數為 0.9 公分(範圍:0.6–3.1 公分,2 例無法量測)。 治療方面,有 3 位患者採觀察、3 位接受局部治療(2 位手術切除,1 位接 受射頻消融合併外照射放療)、9 位接受放射性碘治療、7 位接受全身性治 療(有六位患者接受超過一種治療)。初診時,15 位 (88%) 患者屬於 T3 或 T4 的晚期腫瘤分期;10 位 (59%) 具有病理性側頸部淋巴結轉移 (pN1b);5 位 (29%) 已發現遠端轉移 (M1);14 位 (82%) 被歸類為 ATA 高復發風險族 群。追蹤時間中位數為 32.1 個月,其中 13 位 (72%) 出現疾病進展,中位 PFS 為 11.3 個月(範圍:5.1–117.5 個月)。在咽後或咽旁淋巴結轉移診斷 時,甲狀腺球蛋白 (thyroglobulin, Tg) 濃度高於 20 ng/mL 為預後較差的獨 立風險因子 (p = 0.02)。 結論:咽後或咽旁淋巴結轉移雖罕見,但往往代表疾病具有侵襲性。高 Tg 濃度與較差的預後相關,凸顯其作為預後指標的重要性。 |
| 英文摘要 | Background: Lymph node (LN) metastasis is common in papillary thyroid cancer (PTC) and accounts for 20%–50% of patients. However, the development of LN metastasis in retropharyngeal or parapharyngeal (RP/PP) space is rare. The objective of this study was to evaluate the clinical features and the prognosis of RP/PP LN metastasis in PTC. Methods: A total of 17 PTC cases with RP/PP LN metastasis were retrospectively reviewed from July 2008 to June 2022 in our institute. The clinicopathologic and demographic features, including age, gender, tumor size, extrathyroidal extension, TNM staging, American Thyroid Association (ATA) risk, thyroglobulin (Tg) level, radioiodine avidity, F-18 FDG uptake, and time to progression, were recorded according to medical chart review. RP/PP LN metastases were diagnosed based on imaging, with histopathological confirmation when available. The progression-free survival (PFS) analyses were estimated using the KaplanMeier method. Results: Among the 17 patients, 9 (53%) had RP/PP LN metastasis found at initial presentation, while 8 (47%) developed RP/PP LN metastasis during follow-up. The median age at RP/PP LN diagnosis was 57 years (range, 26–81 years). The median maximum diameter of a metastatic RP/PP LN was 0.9 cm (range, 0.6–3.1 cm, 2 unmeasurable). Regarding management, 3 underwent observation, 3 had locoregional treatment (2 with surgical resection and 1 with radiofrequency ablation plus external beam radiation), 9 received radioiodine therapy, and 7 received systemic therapy (6 patients received more than one treatment modality). At initial diagnosis, 15 patients (88%) had advanced T classification (T3 or T4); 10 patients (59%) had pathological N1b disease; 5 patients (29%) had distant metastasis (M1); 14 patients (82%) were classified as ATA high risk for recurrence. During the median follow-up of 32.1 months, 13 (72%) patients developed progressive disease, with a median PFS of 11.3 months (range, 5.1–117.5). High Tg level (> 20 ng/mL) at RP/PP LN metastasis diagnosis was an independent risk factor of worse PFS (p = 0.02). Conclusions: RP/PP LN metastasis is rare but often indicates aggressive disease. High Tg levels at RP/PP LN metastasis diagnosis imply poor outcomes, highlighting their prognostic significance. |
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