Souza Suzikelli Lisboa, Montalli Da Assumpção Lígia Vera, Ward Laura Sterian
Laboratory of Cancer Molecular Genetics, Department of Medicine, State University of Campinas, São Paulo, Brazil.
Thyroid. 2003 May;13(5):491-5. doi: 10.1089/105072503322021160.
Autoimmune phenomena are frequently associated with differentiated thyroid carcinomas. However, the significance of thyroid gland autoimmune aggression on the outcome of these patients is still controversial. To address this issue, we studied 173 patients (123 with papillary and 50 with follicular carcinomas) who underwent surgery complemented by radioiodine ablation and followed up for 0.5-29 (6 +/- 5.76) years. Analysis of the prognostic factors revealed that higher age, male gender, larger nodule size, follicular tumors, presence of metastases at diagnosis, grade of differentiation, and stage correlated positively with the occurrence of death, metastasis and/or recurrence, while the presence of antibodies and the previous history of autoimmune disease correlated negatively with these events. Long distant metastases increased the odds for a lower disease-free rate for patients with papillary (8.366 times) and follicular (7.373 times) carcinoma. However, univariate and multivariate analysis failed to demonstrate that neck node involvement could influence the outcome for patients with well-differentiated thyroid carcinoma. The odds for patients with previous history of thyroid autoimmune disease (p < 0.02) or with thyroid autoantibodies (p < 0.001) to have a worse outcome were lower than for patients with no evidence of autoimmune activity, suggesting that autoimmune activity against the gland may exert a protective effect on the outcome of differentiated thyroid carcinoma patients.
自身免疫现象常与分化型甲状腺癌相关。然而，甲状腺自身免疫攻击对这些患者预后的意义仍存在争议。为解决这一问题，我们研究了173例患者（123例乳头状癌和50例滤泡状癌），这些患者接受了手术并辅以放射性碘消融，随访时间为0.5 - 29（6±5.76）年。预后因素分析显示，年龄较大、男性、结节较大、滤泡状肿瘤、诊断时存在转移、分化程度和分期与死亡、转移和/或复发的发生呈正相关，而抗体的存在和自身免疫疾病史与这些事件呈负相关。远处转移增加了乳头状癌（8.366倍）和滤泡状癌（7.373倍）患者无病生存率降低的几率。然而，单因素和多因素分析均未能证明颈部淋巴结受累会影响分化型甲状腺癌患者的预后。有甲状腺自身免疫疾病史（p < 0.02）或有甲状腺自身抗体（p < 0.001）的患者预后较差的几率低于无自身免疫活动证据的患者，这表明针对甲状腺的自身免疫活动可能对分化型甲状腺癌患者的预后产生保护作用。
