Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
Division of Endocrine Surgery, DeWitt Daughtry Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida.
J Surg Res. 2020 Jan;245:115-118. doi: 10.1016/j.jss.2019.07.025. Epub 2019 Aug 12.
The autoimmune process and increased TSH associated with chronic lymphocytic thyroiditis (CLT) are factors that may promote development of thyroid cancer. When surgically removed, the cellular changes of CLT are commonly seen surrounding thyroid cancers. This study investigates the malignancy rate in CLT patients when compared with non-CLT patients after thyroidectomy.
A retrospective review of prospectively collected data for 1268 patients with index thyroid nodules who underwent thyroidectomy at a single institution was performed. Patients were excluded if they had previous thyroid surgery, known thyroid cancer, Graves' disease, family history of thyroid cancer, and history of radiation exposure. Patients were subdivided into CLT and non-CLT groups by final pathology. Final pathology was reviewed and grouped into cancer in the index thyroid nodule and incidental thyroid cancers. Chi-squared analyses were performed using SAS.
Of 359 patients that met study criteria, 52 had CLT. Overall, the malignancy rate was 37% in both CLT patients (19/52) and non-CLT patients (114/307) (P = 0.86). However, incidental thyroid cancer was found in 15% (8/52) of CLT patients and 10% (31/307) of non-CLT patients (relative risk = 1.52) who had no index nodule cancer. The breakdown of incidental cancer subtype in CLT patients was classic variant papillary thyroid carcinoma (PTC), n = 3; follicular variant PTC, n = 5.
Patients with CLT have a 1.5-fold increased risk of incidental PTC. CLT should be considered a risk factor for incidental thyroid cancer, and patients with this thyroid condition should be counseled and monitored periodically for underlying thyroid malignancy.
慢性淋巴细胞性甲状腺炎（CLT）伴自身免疫过程和 TSH 升高，这些因素可能促进甲状腺癌的发生。当甲状腺被手术切除时，CLT 的细胞变化通常围绕在甲状腺癌周围。本研究旨在比较 CLT 患者和非 CLT 患者在甲状腺切除术后的恶性肿瘤发生率。
对单中心 1268 例甲状腺结节患者的前瞻性数据进行回顾性分析。排除既往有甲状腺手术、已知甲状腺癌、Graves 病、甲状腺癌家族史和辐射暴露史的患者。根据最终病理将患者分为 CLT 和非 CLT 两组。最终病理由两位病理学家审查并分为甲状腺结节内癌症和偶发甲状腺癌。采用 SAS 进行卡方检验。
符合研究标准的 359 例患者中，52 例为 CLT。总体而言，CLT 患者（19/52）和非 CLT 患者（114/307）的恶性肿瘤发生率分别为 37%（P=0.86）。然而，在无甲状腺结节癌的 CLT 患者（8/52）和非 CLT 患者（31/307）中，分别有 15%（8/52）和 10%（31/307）发现偶发甲状腺癌（相对风险=1.52）。CLT 患者偶发癌的亚型为经典型甲状腺乳头状癌（PTC）3 例，滤泡型 PTC 5 例。
CLT 患者发生偶发性 PTC 的风险增加 1.5 倍。CLT 应被视为偶发性甲状腺癌的危险因素，应定期对患有这种甲状腺疾病的患者进行咨询和监测潜在的甲状腺恶性肿瘤。
