Smyth P P, Shering S G, Kilbane M T, Murray M J, McDermott E W, Smith D F, O'Higgins N J
Department of Medicine and Therapeutics, St. Vincent's Hospital and University College Dublin, Ireland.
J Clin Endocrinol Metab. 1998 Aug;83(8):2711-6. doi: 10.1210/jcem.83.8.5049.
The prevalence of thyroid peroxidase autoantibodies (TPO.Ab) was assessed in patients with either breast carcinoma or benign breast disease, and its association with disease outcome in breast carcinoma was studied. TPO.Ab were detected by direct RIA in serum from 121/356 (34.0%) of patients with breast carcinoma, compared with 36/194 (18.5%) of controls (P < 0.001); and in 31/108 (28.7%) with benign breast disease, compared with 12/88 (13.6%) of controls (P < 0.05). Survival analysis in a group of 142 women with breast carcinoma demonstrated that TPO.Ab titres > or = 0.3 U/mL were associated with a significantly better disease-free [relative risk (RR) = 1.84, P < 0.05] and overall survival (RR = 3.46, P < 0.02), compared with those who were TPO.Ab-negative. Better outcome associated with higher TPO.Ab titres was confined to those who had thyroid volumes within the intermediate range (10.1-18.8 mL) and did not further enhance the good outcome recorded when volumes were < or = 10.0 mL or > 18.8 mL. Multivariate survival analysis showed that both TPO.Ab and thyroid volume were independently associated with prognosis in breast carcinoma and that RRs for disease-free survival were of a similar order of magnitude to well-established prognostic indices such as axillary nodal status or tumor size. These findings supply evidence that manifestations of thyroid autoimmunity are associated with a beneficial effect on disease outcome in breast carcinoma and provide the strongest evidence to date of a biological link between breast carcinoma and thyroid disease.
我们评估了乳腺癌患者或乳腺良性疾病患者甲状腺过氧化物酶自身抗体（TPO.Ab）的患病率，并研究了其与乳腺癌疾病转归的相关性。采用直接放射免疫分析法（RIA）检测了121/356例（34.0%）乳腺癌患者血清中的TPO.Ab，而对照组为36/194例（18.5%）（P<0.001）；108例乳腺良性疾病患者中有31例（28.7%）检测到TPO.Ab，对照组为12/88例（13.6%）（P<0.05）。对142例乳腺癌女性患者的生存分析表明，与TPO.Ab阴性患者相比，TPO.Ab滴度≥0.3 U/mL与无病生存期显著延长相关[相对危险度（RR）=1.84，P<0.05]，总生存期也显著延长（RR=3.46，P<0.02）。TPO.Ab滴度较高与较好转归的相关性仅限于甲状腺体积处于中等范围（10.1 - 18.8 mL）的患者，对于甲状腺体积≤10.0 mL或>18.8 mL的患者，并未进一步改善已记录的良好转归。多因素生存分析显示，TPO.Ab和甲状腺体积均与乳腺癌的预后独立相关，无病生存期的RR与腋窝淋巴结状态或肿瘤大小等已确立的预后指标相似。这些发现提供了证据，表明甲状腺自身免疫表现与乳腺癌疾病转归的有益影响相关，并提供了迄今为止乳腺癌与甲状腺疾病之间生物学联系的最有力证据。
