甲状腺乳头状癌合并甲状腺良性疾病的临床病理分析

Clinicopathological Analysis of Papillary Thyroid Carcinoma with Benign Thyroid Disease

目的对比分析甲状腺乳头状癌(Papillary thyroid carcinoma,PTC)合并桥本氏甲状腺炎(Hashimoto’s thyroiditis,HT),PTC合并结节性甲状腺肿(Nodular goiter,NG)和单纯PTC3组的临床病理特征及复发风险分析,提高对甲状腺乳头状癌的诊断和认识。方法检索2016年至2019年于广州市第一人民医院住院治疗,初次行甲状腺切除+中央淋巴结清扫,并且经病理明确诊断为PTC病例,纳入符合条件的病例396例(PTC:264例,PTC-HT:66例,PTC-NG:66例)作进一步回顾性分析。比较PTC合并不同的甲状腺良性疾病之间的临床病理及预后的三组间的流行病学(性别及发病年龄)、实验室检查结果(甲状腺功能及甲状腺抗体滴度水平)、临床病理特征(病理分期、淋巴结转移、包膜侵犯、肿块大小等)、临床分期(AJCC)、风险分级、预后评估等方面的差异性。结果(1)性别与年龄:PTC-HT组对比单纯PTC组女性患病率较高,两组间差异有统计学意义。PTC-NG组较单纯PTC组发病年龄偏大。(2)临床TNM特征比较:对比单纯PTC组,PTC-HT组肿瘤直径更小,微小癌占比高。PTC-NG组较单纯PTC组中多灶癌占比更低。(3)临床病理特征比较:PTC-HT组与PTC相比,PTC-HT组T分期更早。(4)术前甲功水平:对比PTC-HT组和PTC组,两组之间TSH(4.04±3.17 vs 2.76±1.76 uIU/mL),TPOAb(94.31±112.63vs33.65±53.88 IU/mL)PTC-HT组的表达水平显著高于PTC组(Z值分别为-2.876和-5.694)。(5)在基于DTC危险分层对PTC患者进行风险分级及预后评估:对比PTC组,PTC-HT、PTC-NG组预后及风险评估更好,两组间差异有统计学意义。结论对比单纯PTC,PTC-HT多见于女性群体,肿瘤直径更小,微小癌占比高,TSH、TPOAb显著高于单纯PTC。PTC-NG发病年龄偏大,好发于55岁以上人群,多灶癌占比低,癌灶常位于单侧叶腺体内。两组相对单纯PTC组风险分级较低。

Objective To improve diagnosis and awareness of papillary thyroid cancer.Comparative analysis of three groups:Papillary thyroid carcinoma (PTC) with Hashimoto’s thyroiditis (HT),papillary thyroid carcinoma (PTC) with nodular goiter (NG),and papillary thyroid carcinoma (PTC) Of clinicopathological characteristics and risk of recurrence.Methods The clinical data of 396 eligible patients (PTC:264,PTC concurrent with HT:66 cases,PTC concurrent with NG:66 cases) were included in the Guangzhou First People’s Hospital from 2016 to 2019,and underwent thyroidectomy and central lymph node dissection for the first time.For further analysis,compare the clinical pathology and prognosis of three benign thyroid diseases with PTC concurrent with epidemiology (gender and age of onset),laboratory test results (thyroid function and thyroid antibody titer levels),and clinical pathological characteristics (pathology staging,lymph node metastasis,capsular invasion,mass size,etc.),clinical staging (AJCC),risk grading,and prognostic assessment.Results (1) Sex and age:The prevalence rate of women in PTC-HT group is higher than that in PTC group alone,and the difference between the two groups is statistically significant.The onset age of PTC-NG group is older than that of PTC group alone.(2) Comparison of clinical TNM characteristics:Compared with PTC group,PTC-HT group has smaller tumor diameter and higher proportion of micro cancer.The proportion of multifocal cancer in PTC-NG group is lower than that in PTC group.(3) Clinicopathological characteristics comparison:Compared with PTC,PTC-HT group has earlier T stage.(4) Preoperative thyroid function level:Compared with PTC-HT group and PTC group,TSH (4.04±3.17 vs 2.76±1.76 UIU/mL) and TPOAB (94.31±112.63 vs 33.65±53.88 IU/mL) expression level in PTC-HT group were significantly higher than PTC group (Z values were-2.876 and-5.694 respectively).(5) Risk classification and prognosis evaluation of PTC patients based on DTC risk stratification:Compared with PTC group,PTC-HT and PTC-NG groups have better prognosis and risk evaluation,and the difference between the two groups is statistically significant.Conclusion Compared with PTC,PTC-HT is more common in female population,with smaller tumor diameter and higher proportion of small cancers.TSH and TPOAb are significantly higher than PTC.PTC-NG is older in onset age,and is more likely to occur in people over 55 years old.The proportion of multifocal cancer is low,and the cancer foci are often located in unilateral lobe glands.The risk grading was lower in the two groups than in the PTC group.