1 Department of Internal Medicine & Aged Care, Royal Brisbane and Women's Hospital , Herston, Australia .
Thyroid. 2014 Jan;24(1):35-42. doi: 10.1089/thy.2013.0062. Epub 2013 Sep 4.
Serum thyrotropin (TSH) concentration and thyroid autoimmunity may be of prognostic importance in differentiated thyroid cancer (DTC). Preoperative serum TSH level has been associated with higher DTC stage in cross-sectional studies; data are contradictory on the significance of thyroid autoimmunity at the time of diagnosis.
We sought to assess whether preoperative serum TSH and perioperative antithyroglobulin antibodies (TgAb) were associated with thyroid cancer stage and outcome in DTC patients followed by the National Thyroid Cancer Treatment Cooperative Study, a large multicenter thyroid cancer registry.
Patients registered after 1996 with available preoperative serum TSH (n=617; the TSH cohort) or perioperative TgAb status (n=1770; the TgAb cohort) were analyzed for tumor stage, persistent disease, recurrence, and overall survival (OS; median follow-up, 5.5 years). Parametric tests assessed log-transformed TSH, and categorical variables were tested with chi square. Disease-free survival (DFS) and OS was assessed with Cox models.
Geometric mean serum TSH levels were higher in patients with higher-stage disease (Stage III/IV=1.48 vs. 1.02 mU/L for Stages I/II; p=0.006). The relationship persisted in those aged ≥45 years after adjusting for sex (p=0.01). Gross extrathyroidal extension (p=0.03) and presence of cervical lymph node metastases (p=0.003) were also significantly associated with higher serum TSH. Disease recurrence and all-cause mortality occurred in 37 and 38 TSH cohort patients respectively, which limited the power for survival analysis. Positive TgAb was associated with lower stage on univariate analysis (positive TgAb in 23.4% vs. 17.8% of Stage I/II vs. III/IV patients, respectively; p=0.01), although the relationship lost significance when adjusting for age and sex (p=0.34). Perioperative TgAb was not an independent predictor of DFS (hazard ratio=1.12 [95% confidence interval=0.74-1.69]) or OS (hazard ratio=0.98 [95% confidence interval=0.56-1.72]).
Preoperative serum TSH level is associated with higher DTC stage, gross extrathyroidal extension, and neck node metastases. Perioperative TgAb is not an independent predictor of DTC prognosis. A larger cohort is required to assess whether preoperative serum TSH level predicts recurrence or mortality.
血清促甲状腺激素（TSH）浓度和甲状腺自身免疫可能对分化型甲状腺癌（DTC）的预后具有重要意义。横断面研究表明，术前血清 TSH 水平与较高的 DTC 分期相关；但关于诊断时甲状腺自身免疫的意义，数据存在矛盾。
我们试图评估国家甲状腺癌治疗合作研究（一个大型多中心甲状腺癌登记处）中，术前血清 TSH 和围手术期抗甲状腺球蛋白抗体（TgAb）是否与 DTC 患者的癌症分期和结局相关。
分析了 1996 年后登记且有术前血清 TSH（n=617；TSH 队列）或围手术期 TgAb 状态（n=1770；TgAb 队列）的患者的肿瘤分期、持续性疾病、复发和总生存（OS；中位随访 5.5 年）。对数转换的 TSH 采用参数检验，分类变量采用卡方检验。无病生存（DFS）和 OS 采用 Cox 模型评估。
较高分期患者的血清 TSH 几何平均值较高（III/IV 期=1.48 vs. I/II 期 1.02 mU/L；p=0.006）。在调整性别后，这一关系在年龄≥45 岁的患者中仍然存在（p=0.01）。大体甲状腺外延伸（p=0.03）和颈淋巴结转移（p=0.003）也与较高的血清 TSH 显著相关。37 例 TSH 队列患者出现疾病复发，38 例患者死亡，这限制了生存分析的效力。在单因素分析中，阳性 TgAb 与较低的分期相关（阳性 TgAb 在 I/II 期患者中的比例为 23.4%，而在 III/IV 期患者中的比例为 17.8%，分别为；p=0.01），但在调整年龄和性别后，这种关系失去了意义（p=0.34）。围手术期 TgAb 不是 DFS（风险比=1.12 [95%置信区间 0.74-1.69]）或 OS（风险比=0.98 [95%置信区间 0.56-1.72]）的独立预测因素。
术前血清 TSH 水平与较高的 DTC 分期、大体甲状腺外延伸和颈部淋巴结转移相关。围手术期 TgAb 不是 DTC 预后的独立预测因素。需要更大的队列来评估术前血清 TSH 水平是否预测复发或死亡率。
