Pellegriti G, Belfiore A, Giuffrida D, Lupo L, Vigneri R
Istituto di Medicina Interna e Malattie Endocrine e Metaboliche, Cattedra di Endocrinologia, University of Catania, Italy.
J Clin Endocrinol Metab. 1998 Aug;83(8):2805-9. doi: 10.1210/jcem.83.8.4997.
The clinical behavior and outcome was evaluated in 21 nonoccult differentiated thyroid carcinomas occurring in Graves' patients during the period 1982-94 and compared with that of matched tumors occurring in euthyroid controls (n = 70). At surgery, patients with Graves' disease showed distant metastases more frequently than euthyroid patients (3/21 = 14.3% vs. 1/70 = 1.4%, P = 0.0556). Graves' patients also showed a significantly higher cumulative risk of recurrent/progressive distant metastases or total adverse events (odd ratios = 3.14 and 2.07, respectively) as compared with euthyroid patients. At the last follow-up visit, persistence of distant metastases was also more frequent in the Graves' group (P = 0.007), although the cumulative individual dose of radioiodine administered was higher than in the control group (median dose = 805 mCi vs. 350 mCi). Two patients died in the Graves' group vs. none in the control group. Circulating thyroid stimulating antibodies were present in all patients but one and persisted as long as signs of disease were evident. These findings indicate that differentiated thyroid carcinomas in patients with Graves' disease are more aggressive than those occurring in matched euthyroid controls and should, therefore, be managed accordingly.
对1982年至1994年间发生在格雷夫斯病患者中的21例非隐匿性分化型甲状腺癌的临床行为和结局进行了评估，并与甲状腺功能正常的对照组（n = 70）中匹配肿瘤的情况进行了比较。手术时，格雷夫斯病患者发生远处转移的频率高于甲状腺功能正常的患者（3/21 = 14.3% 对1/70 = 1.4%，P = 0.0556）。与甲状腺功能正常的患者相比，格雷夫斯病患者复发/进展性远处转移或总不良事件的累积风险也显著更高（比值比分别为3.14和2.07）。在最后一次随访时，格雷夫斯病组远处转移持续存在的情况也更常见（P = 0.007），尽管给予的放射性碘累积个体剂量高于对照组（中位剂量 = 805 mCi对350 mCi）。格雷夫斯病组有2例患者死亡，而对照组无死亡病例。除1例患者外，所有患者均存在循环甲状腺刺激抗体，且只要疾病迹象明显，抗体就持续存在。这些发现表明，格雷夫斯病患者的分化型甲状腺癌比甲状腺功能正常的匹配对照组中的癌症更具侵袭性，因此应相应地进行处理。
