endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg13011endoserg-13011Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL STUDIESФакторы риска «скрытого» метастатического поражения лимфатических узлов центральной зоны при папиллярном раке щитовидной железы ct1-2n0m0Risk factors for « hidden» central lymph node metastatis in papillary thyroid cancer ct1-2n0m0https://orcid.org/0000-0002-1641-6452СолодкийВ. А.SolodkiyV. A.

Солодкий Владимир Алексеевич, д.м.н., академик РАН

Москва

Vladimir A. Solodkiy, MD, PhD, Professor

Moscow

director@rncrr.ruhttps://orcid.org/0000-0002-4484-9423ГалушкоД. А.GalushkoD. A.

Галушко Дмитрий Анатольевич, к.м.н.

Москва

 

Dmitri A. Galushko, MD, PhD

Moscow

DGalushco@list.ruhttps://orcid.org/0000-0003-0344-9738АсмарянА. Г.AsmaryanH. G.

Асмарян Айк Гарникович, к.м.н.

Москва

 

 

Hayk G. Asmaryan, MD, PhD

Moscow

asmaryan@gmail.comhttps://orcid.org/0009-0006-6707-5455ЗарандиаГ. К.ZarandiaG. K.

Зарандиа Гига Корнелиевич, аспирант

адрес: Россия, Москва, 117997, ул. Профсоюзная, д. 86

Giga K. Zarandia

86 Profsoyuznaya str., Moscow, 117997

gzrncrr@mail.ruФГБУ «Российский научный центр рентгенорадиологии» Минздрава РоссииРоссияRussian Scientific Center of Roentgenoradiology of the Ministry of Healthcare of the Russian FederationRussian Federation2025010220261931727Copyright © Солодкий В.А., Галушко Д.А., Асмарян А.Г., Зарандиа Г.К., 20262026Солодкий В.А., Галушко Д.А., Асмарян А.Г., Зарандиа Г.К.Solodkiy V.A., Galushko D.A., Asmaryan H.G., Zarandia G.K.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/13011ОБОСНОВАНИЕ

ОБОСНОВАНИЕ: Особенностью папиллярных карцином щитовидной железы является частое лимфогенное метаста зирование. В первую очередь поражаются лимфатические узлы центральной зоны. Согласно современным клиническим рекомендациям, профилактическая лимфодиссекция не показана. В то же время выявление «скрытых» метастазов может привести к изменению стадии заболевания, стратификации группы риска рецидива и повлиять на тактику лечения. ЦЕЛЬ: исследование направлено на выявление ключевых факторов, влияющих на метастазирование в лимфатические узлы VI группы шеи при начальных стадиях папиллярного рака щитовидной железы. МАТЕРИАЛЫ И МЕТОДЫ: проведено одноцентровое неконтролируемое исследование, включающее 319 пациентов с папиллярными карциномами щитовидной железы без клинических признаков регионарного метастазирования в лимфатические узлы (T1-2N0M0, стадия I). Всем пациентам выполнена тиреоидэктомия профилактической центральной шейной лимфодиссекцией.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ: среди 319 пациентов «скрытое» метастатическое поражение лимфатических узлов центральной зоны обнаружено у 36,4%. При многофакторном анализе выявлены предикторы, достоверно повышающие риск метастазирования: возраст <55 лет (p=0,008), экстратиреоидная инвазия (p=0,016), мужской пол (p=0,017), размер опухоли >1 см (p=0,026). ЗАКЛЮЧЕНИЕ: повышенный риск «скрытого» метастазирования в лимфатические узлы центральной зоны при папиллярном раке щитовидной железы с сN0 выявлен у пациентов возрастом моложе 55 лет, с наличием экстратиреоидной инвазии, мужского пола и размером опухолями более 1 см. Эти факторы следует учитывать при выборе объема операции.

BACKGROUND

BACKGROUND. A feature of papillary thyroid carcinomas is the frequent lymphogenic spread. First of all, the lymph nodes of the central zone are affected. According to current clinical guidelines, preventive lymphodissection is currently not indicated. At the same time, the detection of "hidden" metastases can lead to a change in the stage of the disease, stratification of the risk group for recurrence, and influence treatment tactics. Our study is aimed at identifying the key factors influencing metastasis to the lymph nodes of the IV neck group. AIM: The study is aimed at identifying key factors influencing metastasis to the lymph nodes of the sixth group of the neck in the initial stages of papillary thyroid cancer.

MATERIALS AND METHODS

MATERIALS AND METHODS. A single-center uncontrolled study was conducted, including 319 patients with papillary thyroid cancer without clinical signs of regional lymph node metastasis (T1-2N0M0, stage I). All patients underwent thyroidectomy with preventive central cervical lymphodissection. RESULTS. Among 319 patients, a "hidden" metastatic lesion of the lymph nodes of the central zone was found in 36.4%. Multifactorial analysis revealed predictors significantly increasing the risk of metastasis: age <55 years (p=0.008), extrathyroid invasion (p=0.016), male gender (p=0.017), tumor size >1 cm (p=0.026).

CONCLUSIONS

CONCLUSIONS. An increased risk of "hidden" central lymph node metastatis in papillary thyroid cancer with cN0, was detected in patients younger than 55 years old, with the presence of extrathyroid invasion, males and tumors larger than 1 cm. These factors should be taken into account when choosing the amount of surgery.

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The authors declare that there are no conflicts of interest present.