Haymart Megan R, Glinberg Simone L, Liu Jing, Sippel Rebecca S, Jaume Juan C, Chen Herbert
Division of Metabolism, Endocrinology, and Diabetes (MEND), University of Michigan, Ann Arbor, MI 48109, USA.
Clin Endocrinol (Oxf). 2009 Sep;71(3):434-9. doi: 10.1111/j.1365-2265.2008.03489.x. Epub 2008 Dec 3.
It has previously been shown that higher serum TSH is associated with increased thyroid cancer incidence and advanced-stage disease. In the healthy adult population, mean TSH increases with age. As age over 45 years is a known prognostic indicator for thyroid cancer, it is important to know whether higher TSH in patients with thyroid cancer occurs independent of age.
To determine the relationship between higher TSH, cancer and age.
A retrospective cohort study.
A total of 1361 patients underwent thyroid surgery between May 1994 and December 2007 at a single institution. Of these patients, 954 had pathological data, preoperative TSH and complete surgical history available. Data were analysed in relation to age and TSH.
Mean TSH was significantly higher in cancer patients regardless of age < 45 years or >or= 45 years (P = 0.046 and P = 0.027, respectively). When examining age groups < 20, 20-44, 45-59 and >or= 60 years, there was a trend of rising mean TSH with age. Despite the rise in the benign subgroups, mean TSH was consistently higher in those with cancer vs. those without. On multivariate analysis, higher TSH was independently associated with cancer (P = 0.039) and pathological features of Hashimoto's thyroiditis (P = 0.001) but not with age (P = 0.557). On multivariate analysis of high-risk features associated with poor prognosis, there was a significant association between higher TSH and extrathyroidal extension (P = 0.002), whereas there was no clear relationship with age, tumour size > 4 cm, and distant metastases.
Independent of age, thyroid cancer incidence correlates with higher TSH. Higher TSH is associated with extrathyroidal extension of disease.
此前已有研究表明，血清促甲状腺激素（TSH）水平升高与甲状腺癌发病率增加及疾病晚期相关。在健康成年人群中，平均TSH水平随年龄增长而升高。由于45岁以上是甲状腺癌已知的预后指标，因此了解甲状腺癌患者TSH水平升高是否独立于年龄很重要。
确定TSH水平升高、癌症与年龄之间的关系。
一项回顾性队列研究。
1994年5月至2007年12月期间，共有1361例患者在一家机构接受了甲状腺手术。其中954例患者有病理数据、术前TSH及完整的手术史。对数据进行了年龄和TSH相关分析。
无论年龄＜45岁还是≥45岁，癌症患者的平均TSH均显著更高（分别为P = 0.046和P = 0.027）。在检查年龄组＜20岁、20 - 44岁、45 - 59岁和≥60岁时，平均TSH有随年龄上升的趋势。尽管良性亚组中TSH也有升高，但癌症患者的平均TSH始终高于非癌症患者。多因素分析显示，TSH升高与癌症独立相关（P = 0.039）以及桥本甲状腺炎的病理特征相关（P = 0.001），但与年龄无关（P = 0.557）。在对与预后不良相关的高危特征进行多因素分析时，TSH升高与甲状腺外侵犯显著相关（P = 0.002），而与年龄、肿瘤大小＞4 cm及远处转移无明确关系。
独立于年龄，甲状腺癌发病率与TSH升高相关。TSH升高与疾病的甲状腺外侵犯相关。
