Endocrinology and Metabolism Department, Ankara University School of Medicine, İbni Sina Hastanesi Ek Bina M-blok Kat:1, 06100, Sıhhıye, Ankara, Turkey.
Med Oncol. 2013;30(2):589. doi: 10.1007/s12032-013-0589-5. Epub 2013 May 5.
Both insulin resistance (IR) and vitamin D deficiency (VDD) are found to be associated with many cancer types. In this study, we evaluated the presence of IR and VDD in thyroid cancer patients based on controls. Total 344 papillary thyroid cancer and 116 controls were part of the study. Glucose, insulin, homeostasis model analysis-insulin resistance (HOMA-IR) (control group 2.12 ± 0.9 and patient group 3.6 ± 1.1; p < 0.0001), LDL were significantly high; HOMA-S and vitamin D3 levels (control group 19.11 ± 8 and patient group 17 ± 16; p = 0.004) were significantly low in the patient group. Vitamin D deficiency (64/108 in controls vs 166/235; p = 0.026) and insulin resistance (24/108; 115/235; p < 0.0001) were more frequent in papillary thyroid cancer patients. After regression analysis, tumor diameter showed significant association with log-HOMA-IR (B = 0.315; p = 0.017) and log-vitamin D3 (B = 0.207; p = 0.04). Vitamin D deficiency and insulin resistance frequencies show no difference between micro- and macropapillary thyroid cancers. Receiver operating characteristic curve shows the best cutoff point for tumor diameter showing that the presence of lymph node metastasis was 0.65 cm with 81.2 % sensitivity and 52 % specificity. Best cutoff point for the capsular invasion tumor diameter was 0.75 cm with 83.3 % sensitivity and 60.4 % specificity. No difference between follicular and classical type papillary thyroid carcinomas has been yet discovered. As a result, thyroid cancer patients are more insulin resistant and vitamin D3 deficient. Vitamin D3 levels and HOMA-IR index may affect tumor diameter. Tumor size that is lower than 1 cm (0.65-0.75 cm) may be related with capsular invasion and lymph node involvement.
胰岛素抵抗（IR）和维生素 D 缺乏（VDD）都与许多癌症类型有关。在这项研究中，我们根据对照组评估了甲状腺癌患者是否存在 IR 和 VDD。共有 344 例甲状腺乳头状癌患者和 116 例对照组参与了研究。葡萄糖、胰岛素、稳态模型分析胰岛素抵抗（HOMA-IR）（对照组 2.12±0.9，患者组 3.6±1.1；p<0.0001）、LDL 显著升高；HOMA-S 和维生素 D3 水平（对照组 19.11±8，患者组 17±16；p=0.004）在患者组中显著降低。维生素 D 缺乏（对照组 64/108 例，患者组 166/235 例；p=0.026）和胰岛素抵抗（对照组 24/108 例，患者组 115/235 例；p<0.0001）在甲状腺乳头状癌患者中更为常见。回归分析显示，肿瘤直径与 log-HOMA-IR（B=0.315；p=0.017）和 log 维生素 D3（B=0.207；p=0.04）呈显著相关。微乳头状和巨乳头状甲状腺癌患者的维生素 D 缺乏和胰岛素抵抗频率无差异。受试者工作特征曲线显示肿瘤直径的最佳截断点为 0.65cm，灵敏度为 81.2%，特异性为 52%。肿瘤直径的囊外侵犯最佳截断点为 0.75cm，灵敏度为 83.3%，特异性为 60.4%。未发现滤泡型和经典型甲状腺乳头状癌之间有差异。结果显示，甲状腺癌患者更易发生胰岛素抵抗和维生素 D3 缺乏。维生素 D3 水平和 HOMA-IR 指数可能影响肿瘤直径。直径小于 1cm（0.65-0.75cm）的肿瘤可能与囊外侵犯和淋巴结受累有关。
