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分化型甲状腺癌与桥本甲状腺炎共存的患者疾病侵袭性较弱,预后较好。

Differentiated thyroid cancer is associated with less aggressive disease and better outcome in patients with coexisting Hashimotos thyroiditis.

机构信息

Endocrine Institute, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100, Israel.

出版信息

J Clin Endocrinol Metab. 2013 Jun;98(6):2409-14. doi: 10.1210/jc.2013-1309. Epub 2013 Apr 22.

Abstract

BACKGROUND

Evaluation of surgical specimens suggests that patients with Hashimoto thyroiditis (HT) have a higher prevalence of differentiated thyroid cancer. Although patients with HT are reported to present with earlier stage disease, there is controversy as to whether these patients have better prognosis when adjusted for histology and stage at presentation.

OBJECTIVES

To investigate differences between patients with differentiated thyroid cancer patients and without HT for aggressiveness of disease and clinical outcome, and the decline rate of antithyroglobulin antibodies titers over time.

METHODS

A retrospective study using the Rabin Medical Center Thyroid Cancer Registry. Seven hundred fifty-three patients were included and divided into 2 groups of patients with and without HT at diagnosis. Disease severity at presentation was evaluated using the entire cohort, whereas a control group matched for age, gender, histology, and stage was used to evaluate disease course and outcome.

RESULTS

HT was present in 14.2% (n = 107) of included patients and was associated with smaller primary tumor (17.9 vs 21.2 mm, P = .01) and less lymph node involvement (23% vs 34%, P = .02) at presentation. When matched groups were compared, patients with HT received less additional radioactive iodine (RAI) treatments (1.24 vs 1.45, P = .03) and showed lower rates of persistence at 1 year (13% vs 26%, P = .04) and higher rates of disease remission at the end of follow-up (90% vs 79%, P = .05). On multivariate analysis HT was predictive of a lower rate of lymph nodes involvement (odds ratio 0.34, 95% confidence interval 0.17-0.66) and persistent disease at the end of follow-up (odds ratio 0.48, 95% confidence interval 0.24-0.93). Antithyroglobulin antibodies slowly disappeared in most patients with no evidence of disease.

CONCLUSION

Our study demonstrates that HT is associated with a less aggressive form of differentiated thyroid cancer and a better long-term outcome.

摘要

背景

对手术标本的评估表明,桥本甲状腺炎(Hashimoto thyroiditis,HT)患者分化型甲状腺癌的患病率更高。尽管有报道称 HT 患者的疾病分期较早,但对于这些患者在调整组织学和分期后预后是否更好仍存在争议。

目的

研究分化型甲状腺癌患者与无 HT 患者的疾病侵袭性和临床结局的差异,以及抗甲状腺球蛋白抗体滴度随时间的下降率。

方法

这是一项使用 Rabin 医疗中心甲状腺癌登记处的回顾性研究。共纳入 753 例患者,分为诊断时存在和不存在 HT 的两组。使用整个队列评估疾病的严重程度,而使用年龄、性别、组织学和分期相匹配的对照组来评估疾病过程和结局。

结果

HT 存在于 14.2%(n = 107)的纳入患者中,与较小的原发肿瘤(17.9 与 21.2mm,P =.01)和较少的淋巴结受累(23%与 34%,P =.02)相关。当比较匹配组时,HT 患者接受的额外放射性碘(RAI)治疗较少(1.24 与 1.45,P =.03),1 年时持续性较低(13%与 26%,P =.04),随访结束时疾病缓解率较高(90%与 79%,P =.05)。多变量分析显示,HT 可预测淋巴结受累率较低(优势比 0.34,95%置信区间 0.17-0.66)和随访结束时持续性疾病(优势比 0.48,95%置信区间 0.24-0.93)。大多数无疾病证据的患者的抗甲状腺球蛋白抗体缓慢消失。

结论

我们的研究表明,HT 与侵袭性较低的分化型甲状腺癌和更好的长期结局相关。

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