术前合并亚临床甲状腺功能减退症对甲状腺乳头状癌病人预后影响研究

Relationship between preoperative combined subclinical hypothyroidism and prognosis of papillary thyroid carcinoma

目的比较甲状腺乳头状癌术前合并亚临床甲状腺功能减退症的病人和甲状腺功能正常病人的病理学特征和预后差异。方法选取2005年1月至2007年12月间在第二军医大学长征医院行甲状腺乳头状癌根治术的656例病人,比较70例术前合并亚临床甲状腺功能减退症病人和514例甲状腺功能正常病人的各项临床病理因素,并对有差异因素进行二项Logistic多元回归分析。结果在肿瘤大小、是否侵犯包膜及多灶性方面,合并亚临床甲状腺功能减退症的病人和甲状腺功能正常的病人之间的差异无统计学意义,但合并亚临床甲状腺功能减退症的病人较甲状腺功能正常的病人的淋巴结转移率明显降低(8.6%vs.21.8%,P=0.068)结论术前亚临床甲状腺功能减退症TSH升高不能独立预测甲状腺乳头状癌的预后和肿瘤的侵袭性。

Objective To assess the difference between preoperative subclinical hypothyroidism and euthyroidism on prognosis and clinicopathotogical features of papillary thyroid carcinoma （PTC）. Methods A total of 656 patients underwent surgery for PTC between January 2005 and December 2007 in Chang Zheng Hospital Affiliated to Second Military Medical University was enrolled in the study. All the clinical pathological factors between 70 patients with preoperative subclinical hypothyroidism and 514 patients with euthyroidism before the operation were compared. The difference factors were analyzed by multivariate logistic regression analysis. Results No significant difference was observed in tumour size, extrathyroidal extension and multifocality between subclinical hypothyroidism and euthyroid patients. But metastatic rate of lymph nodes in patients with subclinical hypothyroidism was less than that in euthyroid patients （8.6% vs. 21.8%, P=0.068）. Conclusion Subclinical hypothyroidism with elevated TSH is not an independent predictor of tumour aggressiveness and poor prognosis in PTC.