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组织学证实的慢性淋巴细胞性甲状腺炎与分化型甲状腺癌的临床病理特征、淋巴结转移及复发率的关系。

The Association of Histologically Proven Chronic Lymphocytic Thyroiditis with Clinicopathological Features, Lymph Node Metastasis, and Recurrence Rates of Differentiated Thyroid Cancer.

机构信息

Department of Endocrinology and Metabolism, Ankara University Faculty of Medicine, Ankara, Turkey.

Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey.

出版信息

Endocr Pathol. 2021 Jun;32(2):280-287. doi: 10.1007/s12022-020-09653-y. Epub 2020 Nov 13.

Abstract

The influence of chronic lymphocytic thyroiditis (CLT) on clinicopathological features and behavior of differentiated thyroid carcinoma (DTC) is still debated. In the present study, we aimed to evaluate the prognosis of DTC on the presence of CLT. A total of 649 total thyroidectomized patients (379 female, 270 male) with DTC, who had follow-up data for at least 36 months were included. Clinical, histopathological data, preoperative thyroid peroxidase antibody (TPO-ab), thyroglobulin antibody (Tg-ab), thyroid-stimulating hormone (TSH) levels, and presence of recurrent/persistent disease (R/PD) were evaluated retrospectively. Presence of CLT was defined by histopathology. Frequency of CLT was 32% (n = 208) among DTC patients. Mean tumor size (maximal diameter) was smaller in CLT group when compared to non-CLTs (p = 0.006). Capsular invasion, vascular invasion, tumor stage, risk groups, and R/PD were negatively associated with CLT (p < 0.01, p = 0.04, p = 0.03, p = 0.02, p < 0.01, respectively). Extrathyroidal extension was more frequent in non-CLT group when compared CLT (p = 0.052). Preoperative TSH level was positively associated with lymph node metastasis (LNM) and higher in patients with lateral LNM when compared to central LNM (p < 0.01). Central LNM, lateral LNM, stage 4 tumor, and intermediate- and high-risk tumor groups increased the risk of R/PH, 2.5-, 2.9-, 12.7-, 2.3-, and 4.2-fold, respectively. Presence of CLT was independently related with favorable outcomes, as the risk of R/PD was decreased by 0.49-fold. In conclusion, coexistence of CLT was negatively associated with tumor size, capsular invasion, vascular invasion, and tumor stage in DTC. Risk of R/PD was decreased by approximately half in patients with CLT.

摘要

慢性淋巴细胞性甲状腺炎(CLT)对分化型甲状腺癌(DTC)的临床病理特征和行为的影响仍存在争议。本研究旨在评估 CLT 对 DTC 预后的影响。共纳入 649 例接受全甲状腺切除术的 DTC 患者(379 例女性,270 例男性),随访时间至少 36 个月。回顾性评估临床、组织病理学数据、术前甲状腺过氧化物酶抗体(TPO-ab)、甲状腺球蛋白抗体(Tg-ab)、促甲状腺激素(TSH)水平以及是否存在复发性/持续性疾病(R/PD)。通过组织病理学定义 CLT 的存在。在 DTC 患者中,CLT 的发生率为 32%(n=208)。与非 CLT 组相比,CLT 组的肿瘤平均大小(最大直径)较小(p=0.006)。包膜侵犯、血管侵犯、肿瘤分期、风险组和 R/PD 与 CLT 呈负相关(p<0.01,p=0.04,p=0.03,p=0.02,p<0.01 分别)。与 CLT 相比,非 CLT 组更常见甲状腺外侵犯(p=0.052)。术前 TSH 水平与淋巴结转移(LNM)呈正相关,且侧方 LNM 患者的 TSH 水平高于中央 LNM(p<0.01)。中央 LNM、侧方 LNM、IV 期肿瘤和中高危肿瘤组使 R/PH 的风险分别增加 2.5、2.9、12.7、2.3 和 4.2 倍。CLT 的存在与良好的预后独立相关,R/PD 的风险降低了 0.49 倍。总之,CLT 与 DTC 的肿瘤大小、包膜侵犯、血管侵犯和肿瘤分期呈负相关。CLT 患者的 R/PD 风险降低了近一半。

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