甲状腺乳头状癌合并慢性淋巴细胞性甲状腺炎的临床病理特征分析

Clinicopathologic features of papillary thyroid carcinoma with coexistent chronic lymphocytic thyroiditis

目的分析甲状腺乳头状癌(PTC)合并慢性淋巴细胞性甲状腺炎(CLT)患者的临床病理特征。方法回顾性收集笔者所在医院2014年1月至2017年1月期间经病理学检查确诊为PTC的756例患者的临床病理资料,根据术后常规病理学检查结果是否合并CLT分为单纯PTC组(562例)和PTC合并CLT组(194例),比较2组患者在临床资料、超声特征、甲状腺功能指标及病理特征方面的差异有无统计学意义。结果 PTC合并CLT组女性患者比例,血清促甲状腺激素(TSH)、甲状腺球蛋白抗体(TG-Ab)和甲状腺过氧化物酶抗体(TPO-Ab)水平升高者以及多灶癌的比例均明显高于单纯PTC组(P<0.05),2组患者在术前超声、癌灶大小、被膜侵犯、中央组淋巴结转移及TNM分期方面比较差异均无统计学意义(P>0.05);进一步多因素分析结果显示,女性、TG-Ab升高、TPO-Ab升高以及多灶癌是PTC合并CLT的独立风险预测因素(P<0.05)。结论 PTC与CLT之间可能存在一定的关联,合并CLT的PTC好发于女性,以多灶癌多见,但合并CLT并未增加PTC的侵袭性,这可能与CLT限制了PTC结节的发展有关,推测CLT可能是PTC的保护性因素。

Objective To analyze clinical and pathological features of patients with papillary thyroid carcinoma （PTC） with coexistent chronic lymphocytic thyroiditis （CLT）. Methods The clinicopathologic data of 756 cases of PTC were collected from January 2014 to January 2017 in the First Affiliated Hospital, Xinjiang Medical University were collected. The patients were designed to observational group （PTC with coexistent CLT, n=194） and control group （simple PTC, n=562） according to whether CLT was diagnosed by pathology, then the clinical data, ultrasonic features, thyroid function, and pathological features in these two groups were compared. Results The proportion of the female patients, the proportions of theserum thyroid stimulating hormone and thyroid autoimmune antibodies （thyroglobulin antibody and thyroid peroxidase antibody）, and the proportion of multifocal carcinoma in the observational group were significantly higher than those in the control group （P〈O.05）. There were no significant differences in the preoperative ultrasound, tumor diameter, thyroid capsule invasion, central lymph node metastasis, and TNM stage in these two groups （P〉0.05）. The results of the multivariate analysis showed that the female, serum thyroid autoimmune antibodies, and the multifocal carcinoma were the independent predictive factors of PTC with CLT （P〈0.05）. Conclusions There might be a certain correlation between PTC and CLT, PTC with coexistent CLT is more common in female patient and with multifocal carcinoma. With coexistent CLT does not increase invasion of PTC. This may be associated with limit of CLT to development of PTC nodules. It is speculated that CLT may be a protective factor of PTC.