Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.
Faculty of Medicine, University of Oulu, Oulu, Biobank Borealis of Northern Finland, Oulu, Finland.
Int J Cancer. 2024 Sep 15;155(6):1014-1022. doi: 10.1002/ijc.34974. Epub 2024 May 2.
Thyroid cancer more commonly affects women than men and is the third most frequently diagnosed cancer among women of reproductive age. We conducted a nested case-control study within the Finnish Maternity Cohort to evaluate pre-diagnostic sex steroid and thyroid function markers in relation to subsequent maternal papillary thyroid cancer. Cases (n = 605) were women ages 18-44 years, who provided an early-pregnancy (<20 weeks gestation) blood sample and were diagnosed with papillary thyroid cancer up to 11 years afterward. Controls (n = 1185) were matched to cases 2:1 by gestational age, mother's age, and date at blood draw. Odds ratios (ORs) for the associations of serum thyroid peroxidase antibodies (TPO-Ab), thyroglobulin antibodies (Tg-Ab), thyroid stimulating hormone (TSH), free thyroxine (fT4), free triiodothyronine (fT3), progesterone, and estradiol with papillary thyroid cancer were estimated using conditional logistic regression. TPO-Ab and Tg-Ab positivity (>95th percentile among controls) were associated with more than 3-fold (OR = 3.32, 95% confidence interval [CI] 2.33-4.72) and 2-fold (OR = 2.03, 95% CI 1.41-2.93) increased odds of papillary thyroid cancer, respectively. These associations were similar by time since blood draw, parity, gestational age, smoking status, and age and stage at diagnosis. In models excluding TPO-Ab or Tg-Ab positivity, TPO-Ab (quartile 4 vs. 1: OR = 1.66, 95% CI 1.17-2.37, p-trend = .002) and Tg-Ab (quartile 4 vs. 1: OR = 1.74, 95% CI 1.22-2.49, p-trend = .01) levels were positively associated with papillary thyroid cancer. No associations were observed for estradiol, progesterone, TSH, fT3, or fT4 overall. Our results suggest that thyroid autoimmunity in early pregnancy may increase the risk of maternal papillary thyroid cancer.
甲状腺癌在女性中的发病率通常高于男性，是生育年龄妇女中第三常见的癌症。我们在芬兰母婴队列中进行了一项巢式病例对照研究，以评估诊断前性激素和甲状腺功能标志物与随后发生的母亲甲状腺乳头状癌之间的关系。病例组（n=605）为年龄在 18-44 岁的女性，在妊娠早期（<20 周妊娠）提供了一份血样，并在 11 年后被诊断出患有甲状腺乳头状癌。对照组（n=1185）按孕龄、母亲年龄和采血日期与病例组以 2:1 匹配。使用条件逻辑回归估计血清甲状腺过氧化物酶抗体（TPO-Ab）、甲状腺球蛋白抗体（Tg-Ab）、促甲状腺激素（TSH）、游离甲状腺素（fT4）、游离三碘甲状腺原氨酸（fT3）、孕酮和雌二醇与甲状腺乳头状癌的关联的比值比（OR）。TPO-Ab 和 Tg-Ab 阳性（>对照组第 95 百分位数）与甲状腺乳头状癌的风险增加 3 倍以上（OR=3.32，95%置信区间[CI]2.33-4.72）和 2 倍（OR=2.03，95%CI 1.41-2.93）相关。这些关联在距采血时间、产次、孕龄、吸烟状况和诊断时年龄和分期的时间上相似。在排除 TPO-Ab 或 Tg-Ab 阳性的模型中，TPO-Ab（四分位数 4 与 1：OR=1.66，95%CI 1.17-2.37，p-trend=0.002）和 Tg-Ab（四分位数 4 与 1：OR=1.74，95%CI 1.22-2.49，p-trend=0.01）水平与甲状腺乳头状癌呈正相关。雌二醇、孕酮、TSH、fT3 或 fT4 总体上没有关联。我们的研究结果表明，妊娠早期的甲状腺自身免疫可能会增加母亲甲状腺乳头状癌的风险。
