Title Predictive impact of metastatic lymph node burden on distant metastasis across papillary thyroid cancer variants
Journal Thyroid. 2021 Sep 2. doi: 10.1089/thy.2021.0131. Online ahead of print.
Content
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¸²ÇÁÀý ÀüÀÌ°¡ ¸¹À»¼ö·Ï, °©»ó¼±¾ÏÀÇ ¼¼Æ÷ÇÐÀû ¾ÆÇüÀÌ °ø°ÝÀûÀϼö·Ï ¿ø°ÝÀüÀÌ (M1)°¡ Áõ°¡ÇÒ °ÍÀ̶ó´Â °ÍÀº ¿¹»óÇÏ°í ÀÖÀ¸³ª, ÀÌ¿¡ ´ëÇÑ ¿¬±¸´Â ã¾Æº¸±â ¾î·Æ´Ù. º» ¿¬±¸¿¡¼­´Â ¹Ì±¹ÀÇ National Cancer Data Base¸¦ ÀÌ¿ëÇÏ¿©, ¾à 4¸¸8õ¸íÀÇ °©»ó¼±¾Ï ȯÀÚ¸¦ ´ë»óÀ¸·Î (WDPTC (n=39,307), diffuse sclerosing variant (DSV, n=463), tall cell (n=3,752), poorly differentiated thyroid cancer (PDTC, n=1,915), and anaplastic thyroid cancer (ATC, n=2,407)) ¼¼Æ÷ÇÐÀû ¾ÆÇüº° ¿ø°ÝÀüÀ̸¦ ºÐ¼®ÇÑ °á°ú, ÀüüÀûÀ¸·Î 3.8% (n=1,717)ÀÇ È¯ÀÚ¿¡¼­ ¿ø°ÝÀüÀ̸¦ È®ÀÎÇÏ¿´À¸¸ç, ±âÁ¸¿¡ ¾Ë·ÁÁø °ø°ÝÀû ¾ÆÇü Àϼö·Ï ½ÇÁ¦·Î ¿ø°ÝÀüÀÌ°¡ ¸¹Àº °ÍÀ» È®ÀÎÇÏ¿´´Ù (WDPTC (1.0%), DSV (2.3%), tall cell (4.1%), PDTC (17.4%), ATC (38.4%) (p<0.001)). WDPTC¿¡¼­´Â LNÀüÀÌ ¼ö°¡ Áõ°¡ÇÒ¼ö·Ï M1ÀÌ Áõ°¡ÇÏ´Â °ÍÀÌ È®ÀεǾúÀ¸¸ç (0 LN+ (0.5%), 1-5 LN+ (2.0%), 6-10 LN+ (3.4%), >10 LN+ (5.5%) (p<0.001). ´Ùº¯·®ºÐ¼®¿¡¼­ WDPTC (OR 1.06 [1.05-1.08], p<0.001)¿Í tall cell variant (OR 1.04 [1.02-1.07], p<0.001)¿¡¼­ LNÀüÀÌ°¡ Áõ°¡ÇÒ¼ö·Ï M1ÀÇ ºóµµ°¡ À¯ÀÇÇÏ°Ô Áõ°¡ÇÏ¿´À¸³ª, ´Ù¸¥ M1 baseline ºóµµ°¡ ³ôÀº, °ø°ÝÀû ¾ÆÇü¿¡¼­´Â LNÀüÀÌ¿Í M1ÀÇ ºóµµ¿¡¼­ À¯ÀÇÇÑ »ó°ü°ü°è¸¦ È®ÀÎÇÒ ¼ö ¾ø¾ú´Ù (DSV, OR 1.02 [0.95-1.10], p=0.52; PDTC, OR 1.00 [0.98-1.02], p=0.66; ATC, 1.00 [0.98-1.02], p=0.97).
Clinical
importance
¡á WDPTC¿Í tall cell variant¿¡¼­ LNÀüÀÌ°¡ ¸¹À»¼ö·Ï ¿ø°ÝÀüÀÌ°¡ ¹ß»ýÇÒ È®·üÀÌ À¯ÀÇÇÏ°Ô ¸¹¾Ò±â ¶§¹®¿¡, ¼ö¼ú ÈÄ LNÀüÀ̸¦ È®ÀÎÇÏ¿© adjuvant Tx.³ª surveillance¿¡¼­ À̸¦ °í·ÁÇÏ¿©risk stratificationÀ» ÇØ¾ß ÇÒ °ÍÀÌ´Ù. ¶ÇÇÑ LN ÀüÀÌ°¡ ¾ø°Å³ª Àû´õ¶óµµ, DSV, PDTC, ATC¿Í °°Àº ¾ÆÇü¿¡¼­´Â ¿ø°ÝÀüÀÌ°¡ ÀÖÀ» ¼ö ÀÖ¾î, Áø´Ü ¹× Ä¡·á°èȹ¿¡ °í·ÁÇÏ´Â °ÍÀÌ ÇÊ¿äÇÏ´Ù.

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