The University of Jordan School of Medicine, Amman, 11942, Jordan.
Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The University of Jordan School of Medicine, Amman, 11942, Jordan.
Endocrine. 2023 Sep;81(3):432-449. doi: 10.1007/s12020-023-03378-8. Epub 2023 May 2.
The association between papillary thyroid cancer (PTC) and Hashimoto's thyroiditis (HT) remains a matter of debate. Several genetic and environmental factors have been found to influence this association. Because of the variation in these factors among different populations, we conducted a country- and region-based meta-analysis to examine whether the geographic area influences this association.
We searched PubMed and Web of Science databases for original articles that investigated the association between HT and PTC from February 1955 to February 28, 2023. The included studies were stratified according to their country and region of origin. Various subgroup analyses were conducted. The primary outcome was the pooled relative risk (RR) and its 95% confidence interval (CI) for each region and country.
Forty-six studies including a total of 93,970 participants met our inclusion criteria. They originated from 16 countries distributed in five regions. Significant variation was found among countries but not among regions. Upon analysis of all 46 included studies, countries were classified based on their RR and its 95% CI. Excluding countries with pooled sample sizes <500, Sri Lanka (RR 4.23, 95% CI 2.91-6.14), Poland (RR 3.16, 95% CI 2.79-3.57) and Japan (2.68, 2.14-3.36) showed the strongest association between HT and PTC while Greece (RR 1.06, 95% CI 1.00-1.13), Spain (RR 0.70, 95% CI 0.23-2.11), and Jordan (0.62, 0.32-1.32) showed no significant association.
Our findings revealed a variation in the association between HT and PTC among countries but not among regions. The country-to-country variation could be due to certain genetic and/or environmental factors subject to geographic variation that influence this association. These findings may help guide health policies aiming to mitigate the risk of PTC in the HT population by helping identify high-risk and low-risk countries.
甲状腺乳头状癌（PTC）与桥本甲状腺炎（HT）之间的关联仍存在争议。已经发现一些遗传和环境因素会影响这种关联。由于不同人群中这些因素的变化，我们进行了基于国家和地区的荟萃分析，以检查地理区域是否会影响这种关联。
我们在 PubMed 和 Web of Science 数据库中检索了从 1955 年 2 月 1 日至 2023 年 2 月 28 日期间调查 HT 与 PTC 之间关联的原始文章。根据其来源国和地区对纳入的研究进行分层。进行了各种亚组分析。主要结局是每个地区和国家的汇总相对风险（RR）及其 95%置信区间（CI）。
共有 46 项研究纳入了 93970 名参与者，这些研究来自分布在五个地区的 16 个国家。国家之间存在显著差异，但地区之间没有差异。对所有 46 项纳入的研究进行分析后，根据 RR 及其 95%CI 将国家进行分类。排除汇总样本量<500 的国家后，斯里兰卡（RR 4.23，95%CI 2.91-6.14）、波兰（RR 3.16，95%CI 2.79-3.57）和日本（2.68，2.14-3.36）显示出 HT 与 PTC 之间最强的关联，而希腊（RR 1.06，95%CI 1.00-1.13）、西班牙（RR 0.70，95%CI 0.23-2.11）和约旦（0.62，0.32-1.32）则没有显著关联。
我们的研究结果显示，HT 与 PTC 之间的关联在国家之间存在差异，但在地区之间没有差异。国家之间的差异可能是由于影响这种关联的某些遗传和/或环境因素受到地理差异的影响。这些发现可能有助于指导旨在通过识别高风险和低风险国家来降低 HT 人群 PTC 风险的卫生政策。
