Department of Surgery, Chonnam National University Medical School, 322 Seoyang-ro, Hwasun-eup, Hwasun-gun, Jeonnam, 58128, South Korea.
Surg Oncol. 2020 Sep;34:67-73. doi: 10.1016/j.suronc.2020.03.008. Epub 2020 Apr 1.
Chronic lymphocytic thyroiditis (CLT) frequently coexists with papillary thyroid carcinoma (PTC) that exhibits normal thyroid function. However, few studies have investigated the relationship between CLT and clinically lymph node (LN)-negative PTC. The aim of this study was to evaluate the relationship between subclinical central LN metastasis and CLT, and to assess the impact of CLT on the recurrence of clinically LN-negative PTC.
We investigated the medical records of 850 patients with PTC who underwent prophylactic bilateral central neck dissection as well as total thyroidectomy between 2004 and 2010; the median follow-up time was 95.5 months (range, 12-158 months).
CLT was observed in 480 patients (56.5%). Female sex, a preoperative thyroid-stimulating hormone level >2.5 mU/L, a primary tumor ≤1 cm, no gross extrathyroidal extension, high number of harvested LNs, low number of metastatic LNs, and positive anti-thyroglobulin (Tg) antibody at 1 year post-initial treatment were significantly associated with the presence of CLT. Multivariate analysis revealed that patients with N1a stage (vs. N0 stage; hazard ratio [HR], 3.255; 95% confidence interval [CI], 1.290-8.213; p = 0.012) and positive anti-Tg antibody at 1 year post-initial treatment (vs. negative anti-Tg antibody; HR, 5.118; 95% CI, 2.130-12.296; p < 0.001) had poorer recurrence-free survival (RFS), while those with CLT (vs. no CLT; HR, 0.357; 95% CI, 0.157-0.812; p = 0.014) had favorable RFS outcomes.
CLT is associated with less aggressive tumor characteristics and LN metastasis. Clinically LN-negative PTC patients with CLT experience longer RFS intervals than those without CLT.
慢性淋巴细胞性甲状腺炎（CLT）常与甲状腺功能正常的甲状腺乳头状癌（PTC）并存。然而，很少有研究探讨 CLT 与临床无淋巴结（LN）转移的 PTC 之间的关系。本研究旨在评估亚临床中央 LN 转移与 CLT 的关系，并评估 CLT 对临床无 LN 转移的 PTC 复发的影响。
我们调查了 2004 年至 2010 年间接受预防性双侧中央颈部清扫术和全甲状腺切除术的 850 例 PTC 患者的病历；中位随访时间为 95.5 个月（范围，12-158 个月）。
480 例（56.5%）患者存在 CLT。女性、术前促甲状腺激素水平>2.5 mU/L、原发肿瘤≤1cm、无明显甲状腺外侵犯、LN 检出数多、转移 LN 数少、初始治疗后 1 年抗甲状腺球蛋白（Tg）抗体阳性与 CLT 存在显著相关。多变量分析显示，N1a 期（与 N0 期相比；危险比[HR]，3.255；95%置信区间[CI]，1.290-8.213；p=0.012）和初始治疗后 1 年抗-Tg 抗体阳性（与抗-Tg 抗体阴性相比；HR，5.118；95%CI，2.130-12.296；p<0.001）患者的无复发生存率（RFS）较差，而存在 CLT（与不存在 CLT 相比；HR，0.357；95%CI，0.157-0.812；p=0.014）的患者 RFS 结果较好。
CLT 与侵袭性较小的肿瘤特征和 LN 转移相关。存在 CLT 的临床无 LN 转移的 PTC 患者比不存在 CLT 的患者具有更长的 RFS 间隔。
