Wang Weibin, Wen Liping, Chen Shitu, Su Xingyun, Mao Zhuochao, Ding Yongfeng, Chen Zhendong, Chen Yiran, Ruan Jiaying, Yang Jun, Zhou Jie, Teng Xiaodong, Fahey Thomas J, Li Zhongqi, Teng Lisong
Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of General Surgery, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Front Oncol. 2022 May 9;12:881024. doi: 10.3389/fonc.2022.881024. eCollection 2022.
Thyroid autoimmunity is common in papillary thyroid carcinoma (PTC) and was believed to confer a better prognosis; however, controversy still remains. This study aimed to investigate the prognostic value of chronic lymphocytic thyroiditis (CLT) and preoperative thyroid peroxidase antibody (TPOAb) in PTC patients.
A retrospective analysis was performed on 5,770 PTC patients who underwent surgical treatment with pathologically confirmed PTC in our institution between 2012 to 2016. The patients were divided into groups with respect to the coexistence of CLT or preoperative TPOAb levels. The clinicopathological characteristics and disease-free survival (DFS) rates were compared between the groups.
The coexistence of CLT was likely to have bilateral, multifocal tumors. Particularly, PTC patients with TPOAb++ (>1,000 IU/L) had a larger tumor size ( = 0.007) and higher rates of bilaterality and multifocality than those with TPOAb- (TPOAb< 100 IU/L), while for lymph node metastasis and extrathyroidal extension, there is no statistical difference. Tumor recurrence was found in 15 of 425 (3.5%), 9 of 436 (2.1%), and 56 of 3,519 (1.6%) patients with TPOAb++, TPOAb+, and TPOAb-, respectively ( = 0.017). On univariate analysis, TPOAb++ was correlated with tumor recurrence, with a hazard ratio of 2.20 [95% confidence interval (CI), 1.25-3.89], which remained as an independent risk factor at 1.98 (95% CI, 1.10-3.55) on multivariate analysis. PTC patients with TPOAb++ had the lowest DFS rates (96.5 97.9 98.4%, = 0.020).
CLT is not a protective factor in PTC patients. We provide initial evidence that the preoperative TPOAb instead predicts recurrence in papillary thyroid carcinoma.
甲状腺自身免疫在乳头状甲状腺癌（PTC）中很常见，曾被认为可带来较好的预后；然而，争议仍然存在。本研究旨在探讨慢性淋巴细胞性甲状腺炎（CLT）和术前甲状腺过氧化物酶抗体（TPOAb）对PTC患者的预后价值。
对2012年至2016年间在我院接受手术治疗且病理确诊为PTC的5770例患者进行回顾性分析。根据CLT的共存情况或术前TPOAb水平将患者分组。比较各组的临床病理特征和无病生存率（DFS）。
CLT共存时肿瘤更可能为双侧、多灶性。特别是，TPOAb++（>1000 IU/L）的PTC患者肿瘤体积更大（P = 0.007），双侧性和多灶性发生率高于TPOAb-（TPOAb<100 IU/L）的患者，而在淋巴结转移和甲状腺外侵犯方面，无统计学差异。TPOAb++、TPOAb+和TPOAb-的患者中分别有15例（3.5%）、9例（2.1%）和56例（1.6%）出现肿瘤复发（P = 0.017）。单因素分析显示，TPOAb++与肿瘤复发相关，风险比为2.20[95%置信区间（CI），1.25 - 3.89]，多因素分析时其作为独立危险因素，风险比为1.98（95%CI，1.10 - 3.55）。TPOAb++的PTC患者DFS率最低（96.5% 对97.9% 对98.4%，P = 0.020）。
CLT不是PTC患者的保护因素。我们提供了初步证据，表明术前TPOAb反而可预测乳头状甲状腺癌的复发。
