Yuan Jimeng, Chen Zhendong, Zhang Jing, Chen Xianmeng, Chen Shitu, Wang Xumeng, Zhang Junbin, Su Xingyun, Zhu Weipu, Sheng Jinghao, Teng Lisong, Wang Weibin
Department of Surgical Oncology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang, China.
Department of Thyroid Oncology, Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing 400000, China.
J Clin Endocrinol Metab. 2025 Feb 18;110(3):668-676. doi: 10.1210/clinem/dgae601.
Papillary thyroid cancer (PTC) is an endocrine malignancy with rapidly increased rate. The relationship between lipids and PTC recurrence need further investigate.
The objective of this study is to investigate the association between preoperative serum lipids levels and the outcomes of PTC patients.
A retrospective cohort study including 3575 patients with PTC from 2012 to 2016 with follow-ups in our institute were enrolled. Preoperative serum lipids were divided into categorical variables by receiver operating curves. Univariable and multivariable Cox regression models were developed and independent risk factors were used to construct a nomogram to predict disease-free survival (DFS) rate.
Among the 3575 patients, the mean follow-up time was 56.7 months. Comparing with the patients with high levels of triglyceride (TAG ≥ 0.605 mmol/L) and high-density lipoprotein (HDL ≥ 0.935 mmol/L), those with low levels of TAG (hazard ratio [HR] 2.20, 95% CI 1.30-3.72) and HDL (HR 1.60, 1.00-2.57) had a significantly higher risk of recurrence in PTCs. The 5-year DFS rate of patients with low levels of TAG was 94.4%, which was much lower than that in the high-level group (97.2%, P < .001). While cholesterol (P = .13), low-density lipoprotein (P = .07), and very low-density lipoprotein (P = .15) were not statistically correlated with recurrence of PTCs. The nomogram model showed clinical predictive value with a c-index of 0.80 (95% CI 0.73-0.87) and 0.82 (95% CI 0.73-0.90) for 3- and 4-year DFS in the training cohorts.
In the present study, we provide initial evidence that low levels of TAG and HDL were independently associated with the recurrence of PTC, indicating that preoperative serum concentrations of lipids are helpful in predicting the prognosis for patients with PTC in clinical practice.
甲状腺乳头状癌（PTC）是一种发病率迅速上升的内分泌恶性肿瘤。脂质与PTC复发之间的关系有待进一步研究。
本研究旨在探讨术前血清脂质水平与PTC患者预后的相关性。
纳入一项回顾性队列研究，研究对象为2012年至2016年在我院接受随访的3575例PTC患者。通过受试者工作曲线将术前血清脂质分为分类变量。建立单变量和多变量Cox回归模型，并使用独立危险因素构建列线图以预测无病生存率（DFS）。
在3575例患者中，平均随访时间为56.7个月。与甘油三酯（TAG≥0.605 mmol/L）和高密度脂蛋白（HDL≥0.935 mmol/L）水平较高的患者相比，TAG（风险比[HR]2.20，95%CI 1.30 - 3.72）和HDL（HR 1.60，1.00 - 2.57）水平较低的患者PTC复发风险显著更高。TAG水平较低的患者5年DFS率为94.4%，远低于高水平组（97.2%，P <.001）。而胆固醇（P = 0.13）、低密度脂蛋白（P = 0.07）和极低密度脂蛋白（P = 0.15）与PTC复发无统计学相关性。列线图模型在训练队列中对3年和4年DFS的c指数分别为0.80（95%CI 0.73 - 0.87）和0.82（95%CI 0.73 - 0.90），显示出临床预测价值。
在本研究中，我们提供了初步证据，表明低水平的TAG和HDL与PTC复发独立相关，这表明术前血清脂质浓度有助于在临床实践中预测PTC患者的预后。
