Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Pisa, Pisa, Italy.
Department of Surgical, Medical, Molecular Pathology and Critical Area, Anatomic Pathology Section, University of Pisa, Pisa, Italy.
Endocr Relat Cancer. 2023 Jun 2;30(7). doi: 10.1530/ERC-23-0042. Print 2023 Jul 1.
The relevance of thyroid autoimmunity to the prognosis of papillary thyroid carcinoma is still unsettled. We decided to investigate the impact of thyroid autoimmunity on the prognosis of papillary thyroid carcinoma and the handling of TgAbs. We evaluated the clinical course of a large group of patients according to the presence (PTC-LT) or absence (PTC) of lymphocytic thyroiditis at histology. We studied 194 consecutive patients with a diagnosis of PTC and treated them with total thyroidectomy plus ¹³¹I ablation between 2007 and 2009. Median follow-up (with 25th-75th percentiles) was 84.0 (56.4-118.0) months. The remission criteria were: basal Tg < 0.2 ng/mL (or stimulated Tg: < 1), TgAbs < 8 IU/mL (otherwise 'decreasing TgAb trend', a decline of ≥20% in sequential TgAb measurements) and unremarkable imaging. PTC-LT and PTC patients had comparable treatment.TgAbs were detectable in 72.5% of PTC-LT and 16.5% of PTC patients. Time to remission was longer in the detectable than in the undetectable TgAb cohort (28.5 vs· 7.5 months (median); HR: 0.54, CI: 0.35-0.83, P = 0.005). When comparing PTC-LT to PTC patients, the difference was maintained in the detectable TgAb (29.3 vs 13.0 months; HR: 0.38, CI: 0.18-0.80; P = 0.01) but not in the undetectable TgAb cohort (7.7 vs 7.3 months; HR: 0.90, CI: 0.55-1.47; P = 0.68). Using the decreasing TgAb trend, the influence of detectable TgAbs on time to remission was abolished. Thyroid autoimmunity does not influence the prognosis of papillary thyroid carcinoma. A decreasing TgAb trend seems an appropriate criterion to establish the remission of papillary thyroid carcinoma.
甲状腺自身免疫与甲状腺乳头状癌的预后相关仍存在争议。我们决定研究甲状腺自身免疫对甲状腺乳头状癌预后的影响以及 TgAbs 的处理方法。我们根据组织学上是否存在淋巴细胞性甲状腺炎（PTC-LT）将一组大样本患者的临床过程进行评估。我们研究了 194 例连续诊断为 PTC 的患者，并在 2007 年至 2009 年期间对其进行了甲状腺全切除术加¹³¹I 消融治疗。中位随访（25%-75%）时间为 84.0（56.4-118.0）个月。缓解标准为：基础 Tg<0.2ng/mL（或刺激 Tg：<1）、TgAbs<8IU/mL（否则为“TgAb 下降趋势”，即连续 TgAb 测量值下降≥20%）和无明显影像学异常。PTC-LT 和 PTC 患者的治疗相似。在 PTC-LT 患者中，72.5%的患者可检测到 TgAbs，而 PTC 患者中则为 16.5%。可检测到 TgAb 的患者达到缓解的时间长于未检测到 TgAb 的患者（28.5 比 7.5 个月（中位数）；HR：0.54，CI：0.35-0.83，P=0.005）。与 PTC 患者相比，在可检测到 TgAb 的患者中，差异仍然存在（29.3 比 13.0 个月；HR：0.38，CI：0.18-0.80；P=0.01），而在未检测到 TgAb 的患者中则没有差异（7.7 比 7.3 个月；HR：0.90，CI：0.55-1.47；P=0.68）。使用 TgAb 下降趋势这一标准后，可检测到的 TgAbs 对缓解时间的影响被消除。甲状腺自身免疫不会影响甲状腺乳头状癌的预后。TgAb 下降趋势似乎是确定甲状腺乳头状癌缓解的适当标准。
