Department of Otolaryngology-Head & Neck Surgery, Boston Medical Center, Boston, MA, United States of America.
Department of Otolaryngology - Head & Neck Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
Am J Otolaryngol. 2019 Jul-Aug;40(4):536-541. doi: 10.1016/j.amjoto.2019.04.013. Epub 2019 Apr 22.
As imaging technology improves and more thyroid nodules and malignancies are identified, it is important to recognize factors associated with malignancy and poor prognosis. Vitamin D has proven useful as a prognostic tool for other cancers and may be similarly useful in thyroid cancer. This study explores the relationship of Vitamin D to papillary thyroid carcinoma stage while accounting for socioeconomic covariates.
The medical records of all patients who underwent thyroidectomy at one institution between 2000 and 2015 were reviewed. Subjects with non-papillary thyroid cancer pathology, prior malignancy, and without Vitamin D levels were excluded. The remaining 334 patient records were examined for cancer stage, Vitamin D levels, Vitamin D deficiency listed in history, and demographic and comorbid factors.
Vitamin D laboratory values showed no significant relationship to cancer stage (p = 0.871), but patients with Vitamin D deficiency documented in the medical record were more likely to have advanced disease (28.6% versus 14.7%; p = 0.028). The patients with documented Vitamin D deficiency also had lower 25-hydroxyvitamin D nadirs (21.5 ng/mL versus 26.5 ng/mL, p = 0.008) and were more likely to be on Vitamin D supplementation (92.6% versus 41.8%, p < 0.001).
The results suggest that Vitamin D deficiency may have value as a negative prognostic indicator in papillary thyroid cancer and that pre-operative laboratory evaluation may be less useful. This is important because Vitamin D deficiency is modifiable. While different racial subgroups had different rates of Vitamin D deficiency, neither race nor socioeconomic status showed correlation with cancer stage.
随着成像技术的提高，越来越多的甲状腺结节和恶性肿瘤被发现，因此识别与恶性肿瘤和不良预后相关的因素非常重要。维生素 D 已被证明可作为其他癌症的预后工具，在甲状腺癌中可能同样有用。本研究探讨了维生素 D 与甲状腺乳头状癌分期的关系，同时考虑了社会经济因素。
回顾了 2000 年至 2015 年间在一家机构接受甲状腺切除术的所有患者的病历。排除了非甲状腺乳头状癌病理、既往恶性肿瘤和无维生素 D 水平的患者。检查了 334 例患者的病历，以评估癌症分期、维生素 D 水平、维生素 D 缺乏病史以及人口统计学和合并症因素。
维生素 D 实验室值与癌症分期无显著相关性（p=0.871），但病历中有维生素 D 缺乏记录的患者更可能患有晚期疾病（28.6%比 14.7%；p=0.028）。有记录的维生素 D 缺乏的患者 25-羟维生素 D 最低值也较低（21.5ng/mL 比 26.5ng/mL，p=0.008），且更有可能接受维生素 D 补充治疗（92.6%比 41.8%，p<0.001）。
结果表明，维生素 D 缺乏可能是甲状腺乳头状癌的一个负预后指标，术前实验室评估可能不太有用。这很重要，因为维生素 D 缺乏是可以纠正的。虽然不同的种族亚组维生素 D 缺乏的发生率不同，但种族和社会经济地位均与癌症分期无相关性。
