Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing Dongcheng District, Beijing, 100730, China.
Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
World J Surg Oncol. 2021 Jul 12;19(1):208. doi: 10.1186/s12957-021-02302-6.
An abrupt increase of thyroid cancer has been witnessed paralleling the supplemented iodine intake in formerly iodine-deficient countries. And increased iodine intake has been linked to the rising incidence rate of papillary thyroid cancer (PTC). However, the correlation between iodine and clinicopathological features of PTC has not been well-characterized. This study aimed to investigate the associations between iodine intake and the clinicopathological features of PTC patients.
Three hundred and fifty-nine PTC patients who received surgical treatment in Peking Union Medical College Hospital from May 2015 to November 2020 were retrospectively reviewed. The associations between urinary iodine (UI), urinary iodine/creatinine ratio (UI/U-Cr), and the clinicopathological features of PTC were analyzed. Univariate and multivariate analysis were performed to investigate the relationship between UI level and central lymph node metastasis (CLNM).
There were no significant differences in UI in different groups according to the variables studied, except that patients with CLNM had higher UI level than CLNM(-) patients. No associations were found between UI/U-Cr and clinicopathological features except variant subtypes (classic/follicular). After dividing patients into high-iodine group and low-iodine group, more patients were found to have CLNM in the high-iodine group (p = 0.02). In addition, younger age, larger tumor size, and classic variant were positively correlated with CLNM (p < 0.05). Univariate analysis showed that insufficient iodine intake (≤ 99 μg/L) was associated with decreased CLNM risk in PTC. And after defining insufficient iodine intake as ≤ 109 μg/L and above requirements as ≥ 190 μg/L, multivariate analysis showed that lower iodine was associated with CLNM in total population of PTC (OR 0.53, 95% CI 0.31-0.91) and in PTC < 1 cm (papillary thyroid microcarcinoma, PTMC) (OR 0.43, 95% CI 0.21-0.87).
Low iodine was a protective factor for CLNM in papillary thyroid cancer, particularly in those < 1 cm. These results indicated that iodine may not only be an initiator of tumorigenesis, but also a promoter of the development of PTC.
在曾经碘缺乏的国家，随着碘补充摄入的增加，甲状腺癌的发病率也呈急剧上升趋势。而碘摄入增加与甲状腺乳头状癌（PTC）的发病率上升有关。然而，碘与 PTC 的临床病理特征之间的相关性尚未得到很好的描述。本研究旨在探讨碘摄入与 PTC 患者临床病理特征之间的关系。
回顾性分析 2015 年 5 月至 2020 年 11 月在北京协和医院接受手术治疗的 359 例 PTC 患者的临床资料。分析尿碘（UI）、尿碘/肌酐比值（UI/U-Cr）与 PTC 临床病理特征的关系。采用单因素和多因素分析 UI 水平与中央淋巴结转移（CLNM）的关系。
除 CLNM 患者的 UI 水平高于 CLNM（-）患者外，根据研究的变量，各组之间的 UI 无显著差异。UI/U-Cr 与临床病理特征之间无关联，除变异亚型（经典/滤泡）外。将患者分为高碘组和低碘组后，高碘组的 CLNM 患者更多（p = 0.02）。此外，年龄较小、肿瘤较大和经典变异与 CLNM 呈正相关（p < 0.05）。单因素分析显示，碘摄入不足（≤99μg/L）与 PTC 患者 CLNM 风险降低相关。将碘摄入不足定义为≤109μg/L，碘摄入充足定义为≥190μg/L，多因素分析显示，总体 PTC 患者（OR 0.53，95%CI 0.31-0.91）和 PTC < 1cm（甲状腺微小乳头状癌，PTMC）（OR 0.43，95%CI 0.21-0.87）中，低碘与 CLNM 相关。
低碘是 PTC 患者 CLNM 的保护因素，尤其是在肿瘤直径<1cm 的患者中。这些结果表明，碘不仅可能是肿瘤发生的启动因素，也是 PTC 发展的促进因素。
