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在滤泡细胞来源的甲状腺癌患者中，一级亲属中有非髓样甲状腺癌家族史与更具侵袭性的疾病相关。

In patients with thyroid cancer of follicular cell origin, a family history of nonmedullary thyroid cancer in one first-degree relative is associated with more aggressive disease.

机构信息

Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA.

出版信息

Thyroid. 2012 Jan;22(1):3-8. doi: 10.1089/thy.2011.0192. Epub 2011 Dec 2.

DOI:10.1089/thy.2011.0192

PMID:22136209

Abstract

BACKGROUND

About 5% of nonmedullary thyroid cancers (NMTCs) are familial. Most patients with a family history of thyroid cancer do not meet the definition of familial NMTC (FNMTC; two or more affected family members). The aim of this study was to determine whether patients with a family history of NMTC, but who do not meet the definition of FNMTC, have more aggressive disease.

METHODS

A database of 1502 thyroidectomies was reviewed and 358 patients with NMTC who did not have a family history of benign thyroid disease and who underwent thyroidectomy from January 1994 to December 2008 were identified. These included 324 (90%) patients with papillary thyroid carcinoma (PTC), 24 (7%) with follicular thyroid cancer, and 10 (3%) with anaplastic or Hürthle cell carcinoma. Among them, those with and without a family history of NMTC in first-degree relatives were compared. Then patients with only one affected family member were compared with FNMTC patients.

RESULTS

Thirty-seven (10%) patients had a family history of thyroid cancer, all to of which had PTC. Patients with a family history of NMTC had a similar tumor size than those without (2±0 vs. 2.1±0 cm, p=0.72) but they were significantly younger (43±3 vs. 49±1 years, p=0.04), and more likely to have multicentricity (48% vs. 22%, p=0.01), malignant lymph nodes (22% vs. 11%, p=0.02), and local invasion to surrounding tissues (5.4% vs. 0.6%, p=0.007). They also had a higher recurrence rate (24% vs. 12%, p=0.03) than patients without a family history. Interestingly, patients with only one affected family member were similar to FNMTC patients with respect to age (44±4 vs. 40±3 years, p=0.4), tumor size (2±0 vs. 1.9±0 cm, p=0.65), rate of multicentricity (44% vs. 52%, p=0.57), malignant lymph nodes (22% vs. 21%, p=0.93), local invasiveness (5.5% vs. 11%, p=0.59), and disease recurrence (28% vs. 21%, p=0.56).

CONCLUSION

Patients with NMTC having a family history of thyroid cancer have more aggressive disease, regardless of whether they meet the current definition of FNMTC regarding number of affected family members. Therefore, any positive family history should be considered a risk factor for more aggressive thyroid carcinoma.

摘要

背景

约 5%的非髓样甲状腺癌（NMTC）为家族性。大多数有甲状腺癌家族史的患者不符合家族性 NMTC（FNMTC；两个或两个以上受影响的家族成员）的定义。本研究旨在确定家族性 NMTC 病史但不符合 FNMTC 定义的患者是否具有更具侵袭性的疾病。

方法

对 1502 例甲状腺切除术的数据库进行了回顾性分析，1994 年 1 月至 2008 年 12 月期间，确定了 358 例无良性甲状腺疾病家族史且接受甲状腺切除术的 NMTC 患者。其中，324 例（90%）为甲状腺乳头状癌（PTC），24 例（7%）为滤泡性甲状腺癌，10 例（3%）为间变性或 Hurthle 细胞癌。在这些患者中，比较了有和无一级亲属 NMTC 家族史的患者。然后将仅有一名受影响家庭成员的患者与 FNMTC 患者进行比较。

结果

37 例（10%）患者有 NMTC 家族史，均为 PTC。有 NMTC 家族史的患者肿瘤大小与无家族史的患者相似（2±0 与 2.1±0cm，p=0.72），但年龄明显更小（43±3 与 49±1 岁，p=0.04），更有可能为多中心性（48%与 22%，p=0.01），有恶性淋巴结（22%与 11%，p=0.02）和局部侵犯周围组织（5.4%与 0.6%，p=0.007）。与无家族史的患者相比，他们的复发率也更高（24%与 12%，p=0.03）。有趣的是，仅有一名受影响家庭成员的患者与 FNMTC 患者在年龄（44±4 与 40±3 岁，p=0.4）、肿瘤大小（2±0 与 1.9±0cm，p=0.65）、多中心性（44%与 52%，p=0.57）、恶性淋巴结（22%与 21%，p=0.93）、局部侵袭性（5.5%与 11%，p=0.59）和疾病复发率（28%与 21%，p=0.56）方面无差异。