Prinzi Natalie, Sorrenti Salvatore, Baldini Enke, De Vito Corrado, Tuccilli Chiara, Catania Antonio, Coccaro Carmela, Bianchini Marta, Nesca Angela, Grani Giorgio, Mocini Renzo, De Antoni Enrico, D'Armiento Massimino, Ulisse Salvatore
Department of Experimental Medicine, "Sapienza" University, Rome, Italy.
Department of Surgical Sciences, "Sapienza" University, Rome, Italy.
PLoS One. 2015 Mar 31;10(3):e0122958. doi: 10.1371/journal.pone.0122958. eCollection 2015.
We here analyzed the prevalence of extra-thyroidal malignancies (EM) in 6,386 female patients affected by different thyroid disease (TD). At first, an age-matched analysis of EM in all patients was performed. We then evaluated EM prevalence in four TD diagnostic categories: non-nodular TD (n = 2,159); solitary nodule (n = 905); multinodular TD (n = 2,871); differentiated thyroid cancers (n = 451). Finally, patients were grouped based on the absence (n = 3,820) or presence of anti-thyroglobulin (TgAb) and/or anti-thyroperoxidase (TPOAb) (n = 2,369), or anti-Thyroid Stmulating Hormone (TSH) receptor autoantibodies (n = 197). A total of 673 EM were recorded. EM prevalence in TD patients was higher compared to the general population (Odds Ratio, OR 3.21) and the most frequent EM was breast cancer (OR 3.94), followed by colorectal (OR 2.18), melanoma (OR 6.71), hematological (OR 8.57), uterus (OR 2.52), kidney (OR 3.40) and ovary (OR 2.62) neoplasms. Age-matched analysis demonstrated that the risk of EM was maximal at age 0-44 yr (OR 11.28), remaining lower, but significantly higher that in the general population, in the 45-59 and 60-74 year age range. Breast and hematological malignancies showed an increased OR in all TD, while other cancers associated with specific TD. An increased OR for melanoma, breast and hematological malignancies was observed in both TPOAb and/or TgAb autoantibody negative and positive patients, while colorectal, uterus, kidney and ovary cancers showed an increased OR only in thyroid autoantibody negative patients. In conclusions, women affected by both benign and malignant TD, especially at a younger age and in absence of thyroid autoimmunity, have an increased risk of developing primary EM, thus requiring a careful follow-up and surveillance.
我们在此分析了6386例患有不同甲状腺疾病（TD）的女性患者甲状腺外恶性肿瘤（EM）的患病率。首先，对所有患者进行了EM的年龄匹配分析。然后，我们评估了四种TD诊断类别中的EM患病率：非结节性TD（n = 2159）；孤立结节（n = 905）；多结节性TD（n = 2871）；分化型甲状腺癌（n = 451）。最后，根据是否存在抗甲状腺球蛋白（TgAb）和/或抗甲状腺过氧化物酶（TPOAb）（n = 2369）或抗促甲状腺激素（TSH）受体自身抗体（n = 197）将患者分组。共记录到673例EM。TD患者中EM的患病率高于普通人群（优势比，OR 3.21），最常见的EM是乳腺癌（OR 3.94），其次是结直肠癌（OR 2.18）、黑色素瘤（OR 6.71）、血液系统肿瘤（OR 8.57）、子宫肿瘤（OR 2.52）、肾脏肿瘤（OR 3.40）和卵巢肿瘤（OR 2.62）。年龄匹配分析表明，EM风险在0至44岁时最高（OR 11.28），在45至59岁和60至74岁年龄范围内虽有所降低，但仍显著高于普通人群。乳腺癌和血液系统恶性肿瘤在所有TD中OR均升高，而其他癌症与特定TD相关。在TPOAb和/或TgAb自身抗体阴性和阳性患者中均观察到黑色素瘤、乳腺癌和血液系统恶性肿瘤的OR升高，而结直肠癌、子宫癌、肾癌和卵巢癌仅在甲状腺自身抗体阴性患者中OR升高。总之，患有良性和恶性TD的女性，尤其是年轻且无甲状腺自身免疫的女性，发生原发性EM的风险增加，因此需要仔细的随访和监测。
