Ma Chi, Xu Jie, Zheng Guibin, Liu Lujia, Song Xicheng, Zheng Haitao
Department of Thyroid Surgery, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, 264000, Shandong Province, China.
Department of Nutrition, Yantai Yuhuangding Hospital Affiliated to Qingdao University, Yantai, 264000, Shandong Province, China.
Ann Surg Oncol. 2025 Aug 10. doi: 10.1245/s10434-025-17842-4.
The coexistence of papillary thyroid carcinoma (PTC) and Hashimoto's thyroiditis (HT) presents a clinically significant yet controversial association in endocrine pathology. This study aimed to systematically evaluate the potential inverse associations between HT and PTC progression through comprehensive clinicopathological analysis.
We conducted a retrospective cohort study of 6963 surgical PTC patients treated at our tertiary referral center between 2009 and 2023. Using propensity score matching to control for baseline confounders, we performed Chi-square tests and logistic regression analyses adjusted for key pathological parameters.
Overall, 6963 patients were included in this study. Analysis revealed that male patients with PTC had a lower risk of concurrent HT (odds ratio [OR] 0.29, p < 0.001) and HT-positive patients were significantly younger than their HT-negative counterparts (p = 0.02). Propensity score-matched analysis demonstrated that HT served as a protective factor against lymph node metastasis (OR 0.802, p < 0.001), tumor capsular invasion (OR 0.86, p = 0.004), and BRAF V600E mutation (OR 0.579, p = 0.039). In subgroup analyses, the association between HT and PTC was exclusively observed in female patients, with its correlation with reduced lymph node metastasis primarily seen in the <55 years age group, while the inverse association with capsular invasion was more pronounced in the ≥55 years age group.
These findings suggest potential sex- and age-dependent associations between HT and less aggressive PTC characteristics, with the strongest correlations observed for reduced metastatic tendency in younger women and decreased local invasion in older patients. The observed BRAF mutation modulation suggests potential immune-mediated tumor microenvironment alterations warranting further molecular investigation.
甲状腺乳头状癌（PTC）与桥本甲状腺炎（HT）并存在内分泌病理学中是一种具有临床意义但存在争议的关联。本研究旨在通过全面的临床病理分析系统评估HT与PTC进展之间潜在的负相关关系。
我们对2009年至2023年在我们的三级转诊中心接受手术治疗的6963例PTC患者进行了回顾性队列研究。使用倾向评分匹配来控制基线混杂因素，我们进行了卡方检验和针对关键病理参数进行调整的逻辑回归分析。
总体而言，本研究纳入了6963例患者。分析显示，患有PTC的男性患者并发HT的风险较低（比值比[OR] 0.29，p < 0.001），且HT阳性患者明显比HT阴性患者年轻（p = 0.02）。倾向评分匹配分析表明，HT是淋巴结转移（OR 0.802，p < 0.001）、肿瘤包膜侵犯（OR 0.86，p = 0.004）和BRAF V600E突变（OR 0.579，p = 0.039）的保护因素。在亚组分析中，仅在女性患者中观察到HT与PTC之间的关联，其与淋巴结转移减少的相关性主要见于年龄<55岁的组，而与包膜侵犯的负相关在年龄≥55岁的组中更为明显。
这些发现表明HT与侵袭性较低的PTC特征之间可能存在性别和年龄依赖性关联，在年轻女性中转移倾向降低以及老年患者局部侵犯减少的相关性最为明显。观察到的BRAF突变调节表明潜在的免疫介导的肿瘤微环境改变值得进一步进行分子研究。
