Morand G B, da Silva S D, Mlynarek A M, Black M J, Payne R J, Hier M P
Department of Otolaryngology - Head and Neck Surgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada.
Departments of Medicine and Oncology, Segal Cancer Centre and Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, QC, Canada.
Clin Otolaryngol. 2017 Dec;42(6):1130-1134. doi: 10.1111/coa.12835. Epub 2017 Mar 2.
The extent of initial surgical management in papillary thyroid cancer (PTC) is controversial. We examined whether the presence of perioperative antithyroglobulin antibodies (TGA) could predict long-term recurrence and occurrence of adverse features among a homogenous group of patients with PTC.
The clinical features of patients with PTC treated at a single institution (Jewish General Hospital, McGill University, Montreal, Canada) were obtained from the medical records, and all clinicopathologic information was reviewed. Only low-risk PTC without clinical evidence of nodal disease before surgery and treated with 30 mCi of radioactive iodine was included in the study.
The chart review retrieved 361 patients with a median follow-up of 85.0 months (Q25-Q75 73-98). Forty-two (11.6%) patients had presence of perioperative TGA. Perioperative TGAs were associated with present extrathyroidal extension (P=.005), unsuspected nodal disease (P=.001) and autoimmune thyroiditis (P<.0001). Overall, 17 (4.7%) patients experienced locoregional recurrence. Perioperative TGAs were a significant predictor of recurrence in univariable (P=.021) but not in multivariable analysis (P=.13).
Presence of perioperative TGAs is associated with aggressive histological features and the presence of thyroiditis. Detection of TGA perioperatively may encourage surgeons to consider more extensive initial surgery.
甲状腺乳头状癌（PTC）初始手术治疗的范围存在争议。我们研究了围手术期抗甲状腺球蛋白抗体（TGA）的存在是否能预测一组同质PTC患者的长期复发及不良特征的发生情况。
从加拿大蒙特利尔麦吉尔大学犹太总医院的病历中获取在单一机构接受治疗的PTC患者的临床特征，并对所有临床病理信息进行回顾。该研究仅纳入术前无淋巴结疾病临床证据且接受30毫居里放射性碘治疗的低风险PTC患者。
图表回顾纳入了361例患者，中位随访时间为85.0个月（四分位间距25%-75%为73-98个月）。42例（11.6%）患者存在围手术期TGA。围手术期TGA与甲状腺外侵犯（P=0.005）、未怀疑的淋巴结疾病（P=0.001）和自身免疫性甲状腺炎（P<0.0001）相关。总体而言，17例（4.7%）患者出现局部区域复发。围手术期TGA在单变量分析中是复发的显著预测因素（P=0.021），但在多变量分析中不是（P=0.13）。
围手术期TGA的存在与侵袭性组织学特征及甲状腺炎的存在相关。围手术期检测到TGA可能会促使外科医生考虑更广泛的初始手术。
