Wang Yu, Zheng Jianwei, Hu Xiaomeng, Chang Qing, Qiao Yu, Yao Xiaofeng, Zhou Xuan
Department of Maxillofacial and Otorhinolaryngological Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China.
Eur J Surg Oncol. 2023 Mar;49(3):560-567. doi: 10.1016/j.ejso.2022.11.014. Epub 2022 Nov 11.
There is approximately 10%-50% of papillary thyroid carcinoma (PTC) patients with Hashimoto's thyroiditis (HT). In this research, we sought to better understand the role of HT in PTC progression as well as lymph node metastasis.
It is a retrospective and cross-sectional study, and 4131 PTC patients who underwent thyroidectomy were finally enrolled. Chi-square test, univariate and multivariate logistic regression analyses were employed to evaluate both the risk factors and the critical roles of HT during PTC metastasis.
In this cohort, 1555 patients (37.6%) were diagnosed with HT. According to multivariate analysis, male sex, high levels of TG and TPOAb, tumor extrathyroidal extension, maximum diameter >1 cm, and multifocality were independent risk factors for both central lymph node metastasis (CLNM) and lateral lymph node metastasis (LLNM). In addition, age <55 years and smoking were risk factors for CLNM, while CLNM was one of the risk factors for LLNM. Furthermore, HT was suggested a valuable protective factor for both CLNM and LLNM. In patients with HT, the total number of central lymph nodes was higher, while the positive rate was lower. Compared with those without HT, age and sex did not predict CLNM and LLNM in patients with HT.
HT is considered a protective factor for both CLNM and LLNM in PTC. For patients with HT, surgeons should pay more attention to the preservation of parathyroid gland and the protection of recurrent laryngeal nerve due to less lymph node metastasis. Otherwise, radical operation is highly recommended.
约10%-50%的甲状腺乳头状癌（PTC）患者合并桥本甲状腺炎（HT）。在本研究中，我们试图更好地了解HT在PTC进展以及淋巴结转移中的作用。
这是一项回顾性横断面研究，最终纳入4131例行甲状腺切除术的PTC患者。采用卡方检验、单因素和多因素逻辑回归分析来评估HT在PTC转移过程中的危险因素及关键作用。
在该队列中，1555例患者（37.6%）被诊断为HT。多因素分析显示，男性、高TG和TPOAb水平、肿瘤甲状腺外侵犯、最大直径>1 cm以及多灶性是中央区淋巴结转移（CLNM）和侧方区淋巴结转移（LLNM）的独立危险因素。此外，年龄<55岁和吸烟是CLNM的危险因素，而CLNM是LLNM的危险因素之一。此外，HT被认为是CLNM和LLNM的一个有价值的保护因素。在HT患者中，中央区淋巴结总数较多，而阳性率较低。与无HT患者相比，年龄和性别不能预测HT患者的CLNM和LLNM。
HT被认为是PTC中CLNM和LLNM的保护因素。对于HT患者，由于淋巴结转移较少，外科医生应更加注意甲状旁腺的保留和喉返神经的保护。否则，强烈建议行根治性手术。
