伴有患侧淋巴结转移的单侧甲状腺乳头状癌腺体切除范围的研究进展OA

Papillary thyroid cancer(PTC)incidence continues to rise,and its classic treatment is centered around surgery.Although most major domestic and international treatment guidelines recommend total thyroidectomy(TT)for PTC patients with cervical lymph node metastasis(cN1 stage),recent studies suggest that lobectomy(LT)may be a reasonable alternative.This article reviews the evidence regarding the choice of extent of thyroid resection in patients with unilateral PTC accompanied by ipsilateral cN1 and no other high-risk factors(such as high-risk subtypes,extrathyroidal extension,extranodal extension,and metastatic lymph nodes>3 cm in diameter),and provides an overview of the latest research progress on this clinically debated topic.The main recent advances are as follows:① In this patient population,LT shows no significant difference from TT in oncological outcomes including overall survival and recurrence-free survival;② Even with the addition of radioactive iodine therapy,no additional benefit is observed;③The decision on the extent of resection requires individualized assessment integrating multiple factors,including lymph node metastatic burden,age,body mass index,tumor location,tumor size and the risk of occult contralateral central lymph node metastasis.However,the existing evidence has limitations,as most conclusions are based on retrospective studies.Future prospective multicenter studies are needed to validate the long-term safety of LT and to explore the value of molecular markers and radiomics in accurately screening patients who may benefit,thereby promoting a more individualized and precise surgical strategy for cN1 PTC.