Résumé
Aims: The role of prophylactic central neck dissection (CND) in the management of papillary thyroid carcinoma (PTC) is controversial. This study reports outcomes of an observational approach in PTC patients without clinical evidence of lymph node metastasis. Materials and Methods: Patients with PTC who had surgery (without prophylactic CND) between January 2000 and December 2008 were included in this study. Recurrence-free survival (RFS) and disease-specific survival (DSS) were calculated using the Kaplan–Meier method. Cox regression was used in multivariable models. Results: Out of 625 patients, 486 (77.8%) were female, 144 (23%) were aged 55 years or more, 73 (11.7%) had macroscopic extrathyroidal extension, and 79 (12.7%) had pT3 or pT4 disease. Samples were collected from 12 (1.9%) patients with lymph node metastasis in the perithyroidal tissue and 2 (0.3%) patients with lymph node metastasis in the lateral neck lymph tissue for frozen section examination. After a median follow-up of 104 months, the 10-year DSS and RFS rates were 99.7% and 90.2%, respectively. The 10-year lymph node recurrence rate in the central compartment was 2.7%. pT3/4 stage was an independent predictive factor for RFS (P < 0.001, hazard ratio 1.966, 95% confidence interval 1.446–2.673). Conclusion: The outcomes of patients with clinically negative lymph nodes in the central compartment were favorable without prophylactic CND
Résumé
<p><b>OBJECTIVE</b>To analyze the results of stage I and II tongue squamous cell carcinomas treated with different treatment modalities.</p><p><b>METHODS</b>The clinical data of 103 patients with stage I and II primary tongue squamous cell carcinoma treated with surgery or radiotherapy alone or combined modality therapy were reviewed retrospectively. The treatment results were compared by Log-rank test, Kaplan-Meier and Chi square test among three groups: surgery alone (S), radiotherapy alone (R) and combined modality therapy (surgery plus preoperative or postoperative radiotherapy, R + S/S + R), and the prognostic factors were also analyzed using Cox regression models.</p><p><b>RESULTS</b>The overall 5-year survival rate (OS) was 82.4% for stage I and 80.0% for stage II disease (P = 0.361). The 5-year survival rates of S, R and R + S/S + R groups were 90.3%, 68.4%, and 84.0%, respectively (P = 0.104). The local recurrence rates of those three groups were 2.5%, 35.7% and 5.7%, respectively (P < 0.001). Occult lymph node metastasis rate was 23.8%, frequently metastasized to level II lymph nodes. The patients with poorly differentiated carcinoma were found to have the highest regional recurrence rate. Local and regional recurrence was revealed as an independent prognostic factor.</p><p><b>CONCLUSION</b>Surgery alone can achieve good treatment result for stage I and II tongue squamous cell carcinomas, and lymph node dissection of level I to IV in the neck is recommended.</p>