Sohn Won, Chang Yoosoo, Cho Yong Kyun, Kim Yejin, Shin Hocheol, Ryu Seungho
Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Cancer Epidemiol Biomarkers Prev. 2020 Oct;29(10):2002-2009. doi: 10.1158/1055-9965.EPI-20-0283. Epub 2020 Jul 22.
This study aimed to evaluate the relationship of serum thyrotropin (TSH) and thyroid hormone concentration with liver cancer mortality.
A cohort of 517,996 Korean adults, who did not have liver cancer at baseline and attended a health screening including free thyroxine (FT4) and TSH, were followed for up to 16 years. High and low TSH and FT4 were defined as those above the upper bound of reference interval and those below the lower bound of reference interval of their corresponding reference intervals, respectively. Mortality information was ascertained through National Death Records. The adjusted HR (aHR) with 95% confidence interval (CI) were estimated using a Cox proportional hazard model.
During a median follow-up of 8.1 years, 376 deaths from liver cancer were identified. Subjects with low FT4 levels were associated with an elevated risk of liver cancer mortality with a corresponding multivariable aHR 2.25 (95% CI: 1.62-3.12) compared with those with normal FT4 levels. Within the euthyroid range, there was also a dose-dependent inverse relationship between FT4 level and liver cancer mortality ( < 0.001). Levels of TSH and free T3 had no significant association with liver cancer mortality.
The risk of liver cancer mortality increased as FT4 level decreased, both within the normal and abnormal ranges of thyroid function.
Thyroid function within the abnormal and normal ranges might affect liver cancer mortality. Further study is warranted to elucidate the role of thyroid hormone in development of liver cancer including the underlying biological mechanism.
本研究旨在评估血清促甲状腺激素（TSH）和甲状腺激素浓度与肝癌死亡率之间的关系。
对517996名韩国成年人进行队列研究，这些人在基线时未患肝癌，并参加了包括游离甲状腺素（FT4）和TSH检测的健康筛查，随访长达16年。TSH和FT4的高值和低值分别定义为高于其相应参考区间上限和低于下限的值。通过国家死亡记录确定死亡率信息。使用Cox比例风险模型估计调整后的风险比（aHR）及其95%置信区间（CI）。
在中位随访8.1年期间，共确定376例肝癌死亡病例。与FT4水平正常的受试者相比，FT4水平低的受试者肝癌死亡风险升高，相应的多变量aHR为2.25（95%CI：1.62 - 3.12）。在甲状腺功能正常范围内，FT4水平与肝癌死亡率之间也存在剂量依赖性负相关（<0.001）。TSH和游离T3水平与肝癌死亡率无显著关联。
在甲状腺功能正常和异常范围内，随着FT4水平降低，肝癌死亡风险均增加。
甲状腺功能在异常和正常范围内可能影响肝癌死亡率。有必要进一步研究以阐明甲状腺激素在肝癌发生中的作用，包括潜在的生物学机制。
