桥本甲状腺炎对甲状腺乳头状癌淋巴结转移及BRAFV600E突变的影响研究

Effect of hashimoto's thyroiditis on lymph node metastasis and BRAFV600E expression in papillary thyroid carcinoma

目的:探讨桥本甲状腺炎(HT)对甲状腺乳头状癌(PTC)及甲状腺乳头状微小癌(PTMC)淋巴结转移及BRAFV600E突变的影响。方法:收集2015~2017年接受治疗的PTC及PTMC患者共210例,按照其是否伴HT分组,分析两组之间的区别。结果:PTC组中,伴HT者更多见于女性(92.1%vs 77.0%,χ^2=3.891,P=0.039),而其肿瘤多灶性亦多于不伴HT者(55.3%vs 36.5%,χ^2=3.615,P=0.045),但具有较低的颈侧区淋巴结转移率(47.4%vs 66.2%,χ^2=3.711,P=0.043)及更低的BRAFV600E突变率(55%vs 73%,χ^2=3.56,P=0.048);PTMC组中,伴HT者具有更低的中央区淋巴结转移率(44.3%vs 55.7%,χ^2=9.229,P=0.002),而且在BRAFV600E突变的病例中,伴HT者中央区淋巴结转移率更低(35.2%vs 65%,χ^2=5.797,P=0.016)。结论:伴HT的PTC和PTMC,其恶性程度相对不伴HT的病例较低,HT对PTC和PTMC的淋巴结转移具有一定的限制作用。

Objective:To investigate the effect of Hashimoto's thyroiditis(HT)on lymph node metastasis and BRAFV600E mutation in papillary thyroid carcinoma(PTC)and papillary thyroid microcarcinoma(PTMC).Methods:A total of 210 patients with PTC and PTMC who were treated from 2015 to 2017 were collected and analyzed according to whether they were associated with HT or not.Results:In the PTC group,PTC with HT were more common in female(7.9%vs 23.0%,χ^2=3.891,P=0.039),and their tumors were more multifocal than those without HT(55.3%vs 36.5%,χ^2=3.615,P=0.045),but with lower cervical lymph node metastasis rate(47.4%vs 66.2%,χ^2=3.711,P=0.043)and lower BRAFV600E mutation rate(55%vs 73%,χ^2=3.56,P=0.048);In the PTMC group,patients with HT had a lower rate of central lymph node metastasis(44.3%vs 55.7%,χ^2=9.229,P=0.002),and in the case of the BRAFV600E mutation,The metastatic rates of central lymph nodes in patients with HT were lower(35.2%vs 65.0%,χ^2=5.797,P=0.016).Conclusion:The PTC and PTMC with HT have a lower degree of malignancy than those without HT.HT has a limited effect on the lymph node metastasis of PTC and PTMC.