Hu Liang, Wu Yijun, Ju Fangyu, Zhang Yaohui, Wang Weilin
Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Gland Surg. 2022 Aug;11(8):1404-1414. doi: 10.21037/gs-22-431.
With the advances in organ transplantation technology and the increased number of organ recipients, more organ transplant recipients are living longer. However, many newly-onset thyroid cancer cases have been found among this population. The question remains in the uncertainty in whether the post-transplant thyroid cancer is more pathologically aggressive than the thyroid cancer in non-organ-transplant recipients. We compared the clinicopathological features of papillary thyroid carcinoma (PTC) between solid organ transplant recipients (SOTR) and the general population, in an attempt to improve the detection rate of post-transplant PTC in SOTR and overall survival prognosis of those patients.
The clinical data of 408 PTC patients in the First Affiliated Hospital of Zhejiang University School of Medicine from July 2013 to April 2019 were retrospectively analyzed. The clinicopathological features were compared between non-organ-transplant recipients with PTC (group A, n=380) and SOTR with newly-onset PTC (group B, n=31) using Chi-square test, Fisher's exact test, Student's -test, and logistic regression.
There were significant differences between these two groups in central compartment lymph node metastasis (P=0.005), multifocality (P=0.003), and maximum tumor diameter (P=0.007). Compared with group A, group B had a higher rate of tumor multifocality, higher rate of lymph node metastasis, and smaller tumor size. In addition, PTC in group B was more aggressive in biological behaviors such as tumor multifocality and lymph node metastasis.
Compared with the general population, PTC after SORT demonstrate a more malignant pathological feature. The examination rate of thyroid cancer in SORT should be increased to improve the overall prognosis after solid organ transplant.
随着器官移植技术的进步以及器官接受者数量的增加，越来越多的器官移植受者寿命延长。然而，在这一人群中发现了许多新发甲状腺癌病例。移植后甲状腺癌在病理上是否比非器官移植受者的甲状腺癌更具侵袭性，这一问题仍存在不确定性。我们比较了实体器官移植受者（SOTR）和普通人群中甲状腺乳头状癌（PTC）的临床病理特征，以提高SOTR中移植后PTC的检出率及这些患者的总体生存预后。
回顾性分析2013年7月至2019年4月浙江大学医学院附属第一医院408例PTC患者的临床资料。采用卡方检验、Fisher精确检验、t检验和逻辑回归，比较PTC非器官移植受者（A组，n = 380）和新发PTC的SOTR（B组，n = 31）的临床病理特征。
两组在中央区淋巴结转移（P = 0.005）、多灶性（P = 0.003）和最大肿瘤直径（P = 0.007）方面存在显著差异。与A组相比，B组肿瘤多灶性发生率更高、淋巴结转移率更高且肿瘤尺寸更小。此外，B组PTC在肿瘤多灶性和淋巴结转移等生物学行为方面更具侵袭性。
与普通人群相比，SORT后的PTC表现出更恶性的病理特征。应提高SORT中甲状腺癌的检查率，以改善实体器官移植后的总体预后。
