甲状腺结节作为格雷夫斯病患者甲状腺癌的危险因素：对接受手术治疗患者的观察性研究的系统评价和荟萃分析

Thyroid nodules as a risk factor for thyroid cancer in patients with Graves' disease: A systematic review and meta-analysis of observational studies in surgically treated patients.

作者信息

Papanastasiou Anastasios, Sapalidis Konstantinos, Goulis Dimitrios G, Michalopoulos Nikolaos, Mareti Evangelia, Mantalovas Stylianos, Kesisoglou Isaak

机构信息

3rd Department of Surgery, "AHEPA" University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

出版信息

Clin Endocrinol (Oxf). 2019 Oct;91(4):571-577. doi: 10.1111/cen.14069. Epub 2019 Aug 13.

DOI:10.1111/cen.14069

PMID:31369161

Abstract

OBJECTIVE

Graves' disease (GD) is an autoimmune thyroid disorder characterized by hyperthyroidism. The incidence of thyroid cancer in patients with GD varies from 0.15% to 15%. There is conflicting evidence on the role of thyroid nodules as a risk factor for thyroid cancer in patients with GD.

DESIGN

Three electronic databases (PubMed, Cochrane Library, Scopus) as well as grey literature sources were searched, from inception until 25 February 2019, for observational studies about the prevalence of thyroid cancer in patients with GD.

PATIENTS

Clinical and ultrasonographic examination was necessary preoperatively for all patients to be classified depending on the presence/absence of thyroid nodules.

MEASUREMENTS

Primary outcome was the incidence of thyroid cancer. The latter was determined after total or near-total thyroidectomy by the histopathologic report. Statistical analysis was performed with revman 5.3 software.

RESULTS

The systematic review and meta-analysis included 7 studies with 2582 patients overall. The prevalence of any thyroid cancer was 11.5%. The presence of at least one thyroid nodule in patients with GD was associated with higher risk for thyroid cancer (odds ratio [OR] 5.3, 95% confidence interval [CI] 2.4-11.6, I 83%). A subgroup analysis showed no difference in thyroid cancer risk in patients with GD according to the number of nodules (solitary versus multiple) (OR 1.4, 95% CI 0.9-2.3, I 0%).

CONCLUSIONS

The presence of thyroid nodules is positively associated with the prevalence of thyroid cancer in surgically treated patients with GD. However, further prospective research is needed as the heterogeneity among the studies is high.

摘要

目的

格雷夫斯病（GD）是一种以甲状腺功能亢进为特征的自身免疫性甲状腺疾病。GD患者中甲状腺癌的发病率在0.15%至15%之间。关于甲状腺结节作为GD患者甲状腺癌危险因素的作用，证据存在冲突。

设计

检索了三个电子数据库（PubMed、Cochrane图书馆、Scopus）以及灰色文献来源，检索时间从数据库建立至2019年2月25日，以查找关于GD患者甲状腺癌患病率的观察性研究。

患者

所有患者术前均需进行临床和超声检查，以便根据是否存在甲状腺结节进行分类。

测量

主要结局是甲状腺癌的发病率。后者在全甲状腺切除术或近全甲状腺切除术后通过组织病理学报告确定。使用RevMan 5.3软件进行统计分析。

结果

系统评价和荟萃分析纳入了7项研究，共2582例患者。任何甲状腺癌的患病率为11.5%。GD患者中至少存在一个甲状腺结节与甲状腺癌风险较高相关（优势比[OR]5.3，95%置信区间[CI]2.4 - 11.6，I² 83%）。亚组分析显示，根据结节数量（单发与多发），GD患者的甲状腺癌风险无差异（OR 1.4，95% CI 0.9 - 2.3，I² 0%）。