Bellini Maria Irene, Lori Eleonora, Forte Flavio, Lauro Augusto, Tripodi Domenico, Amabile Maria Ida, Cantisani Vito, Varanese Marzia, Ferent Iulia Catalina, Baldini Enke, Ulisse Salvatore, D'Andrea Vito, Pironi Daniele, Sorrenti Salvatore
Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
Department of Urology, M. G. Vannini Hospital, Rome, Italy.
Front Oncol. 2022 Sep 23;12:951976. doi: 10.3389/fonc.2022.951976. eCollection 2022.
There is a deep interrelation between the thyroid gland and the kidney parenchyma, with dysfunction of the first leading to significant changes in renal metabolism and . Given the recognition of cancer as a systemic disease, the raise of thyroid tumors and the common association of several malignancies, such as breast cancer, prostate cancer, colorectal cancer, and other, with an increased risk of kidney disease, public health alert for these conditions is warranted. A systematic review of the current evidence on the bidirectional relationship between thyroid and renal cancers was conducted including 18 studies, highlighting patient's characteristics, histology, time for secondary malignancy to develop from the first diagnosis, treatment, and follow-up. A total of 776 patients were identified; median age was 64 years (range: 7-76 years). Obesity and family history were identified as the most common risk factors, and genetic susceptibility was suggested with a potential strong association with Cowden syndrome. Controversy on chemo and radiotherapy effects was found, as not all patients were previously exposed to these treatments. Men were more likely to develop kidney cancer after a primary thyroid malignancy, with 423/776 (54%) experiencing renal disease secondarily. Median time after the first malignancy was 5.2 years (range: 0-20 years). With the advancement of current oncological therapy, the prognosis for thyroid cancer patients has improved, although there has been a corresponding rise in the incidence of multiple secondary malignancy within the same population, particularly concerning the kidney. Surgery can achieve disease-free survival, if surveillance follow-up allows for an early localized form, where radical treatment is recommended.
甲状腺与肾实质之间存在着密切的内在联系，甲状腺功能障碍会导致肾脏代谢发生显著变化。鉴于癌症被视为一种全身性疾病，甲状腺肿瘤的增多以及多种恶性肿瘤（如乳腺癌、前列腺癌、结直肠癌等）与肾病风险增加的常见关联，对这些情况发出公共卫生警报是有必要的。对目前关于甲状腺癌与肾癌双向关系的证据进行了系统综述，纳入了18项研究，重点关注患者特征、组织学、从首次诊断到继发恶性肿瘤发生的时间、治疗及随访情况。共确定了776例患者；中位年龄为64岁（范围：7 - 76岁）。肥胖和家族史被确定为最常见的风险因素，提示存在遗传易感性，且可能与考登综合征有强关联。发现化疗和放疗效果存在争议，因为并非所有患者之前都接受过这些治疗。原发性甲状腺恶性肿瘤后男性更易患肾癌，776例中有423例（54%）继发肾病。首次恶性肿瘤后的中位时间为5.2年（范围：0 - 20年）。随着当前肿瘤治疗的进展，甲状腺癌患者的预后有所改善，尽管同一人群中多种继发恶性肿瘤的发生率相应上升，尤其是涉及肾脏的情况。如果监测随访能发现早期局限性病灶并推荐进行根治性治疗，手术可实现无病生存。
