甲状腺球蛋白抗体和甲状腺过氧化物酶抗体状态对分化型甲状腺癌患者中央区淋巴结影响的多中心临床研究

Effects of thyroid globulin antibody and thyroid peroxidase antibody statuses on central lymph nodes in patients with differentiated thyroid cancer:a multicenter clinical study

目的探讨甲状腺球蛋白抗体(TgAb)及甲状腺过氧化物酶抗体(TPOAb)状态对分化型甲状腺癌(DTC)患者中央区淋巴结转移的影响。方法回顾性分析526例来自9所参研单位收治的行双侧甲状腺切除+双侧中央区淋巴结清扫且术后病理证实为DTC患者的临床病理资料,比较不同TgAb及TPOAb状态DTC患者的临床病理特征的差异以及分析TgAb及TPOAb状态是否是影响DTC患者中央区淋巴结转移的独立危险因素。结果本研究纳入的526例DTC患者中男152例,女374例;年龄(44±11)岁。TgAb+TPOAb+者63例,TgAb+TPOAb-者60例,TgAb-TPOAb+者30例,TgAb-TPOAb-者373例,仅发现这4种不同抗体状态DTC患者在性别方面比较差异有统计学意义即抗体异常的患者女性更为多见(P<0.001),未发现它们在肿瘤大小、血管侵犯、神经侵犯、中央区淋巴结转移、肿瘤多灶性、肿瘤是否双侧方面比较差异有统计学意义(P>0.050)。本研究中央区淋巴结有转移389例,无转移137例,多因素分析结果仅发现患者的年龄和性别是影响中央区淋巴结转移的独立危险因素(P<0.001),但未发现TgAb及TPOAb状态及其他因素与中央区淋巴结转移有关(P>0.050)。结论TgAb和TPOAb状态对于DTC患者的中央区淋巴结转移并无明显影响,这与其他研究结论不太一致,希望在扩大现有样本量、确定新型预测因子后做进一步研究。

Objective To investigate the effects of thyroid globulin antibody(TgAb)and thyroid peroxidase antibody(TPOAb)statuses on central lymph node(CLN)metastasis in patients with differentiated thyroid cancer(DTC).Methods A retrospective analysis was perform ed on 526 patients with DTC confirm ed by pathology from nine participating institutions,who underwent the bilateral thyroidectomy plus bilateral CLN dissection.The clinicopathologic characteristics of different TGAb and TPOAb statuses of patients with DTC were compared,and whether the TGAb and TPOAb statuses were the independent risk factors of CLN metastasis in DTC patients or not was analyzed.Results All of 526 patients with DTC were included in this study,152 were males and 374 were females.The age was(44±11)years old.There were 63 cases of TgAb+TPOAb+,60 cases of TgAb+TPOAb-,30 cases of TgAb-TPOAb+,and 373 cases of TgAb-TPOAb-.It was found that there was a significant difference in the gender among the four different antibody statuses of patients,that was,women with abnormal antibodies were more common(P<0.001),not found that there were related to the tumor size,blood vessel invasion,nerve invasion,CLN metastasis,tumor multifocality,and bilateral tumor or not(P>0.050).In this study,there were 389 cases of CLN with metastasis and 137 cases of CLN without metastasis.The results of multivariate analysis found that the age and gender of the patients were the independent risk factors(P<0.001),but didn’t find the TgAb and TPOAb Statuses and other factors were related to the CLN metastasis(P>0.050).Conclusions Statuses of TGAb and TPOAb aren't obviously associated with CLN metastasis in patients with DTC,which is inconsistent with other studies.It needs to be further researched after expanding existing sample size and determining new predictive factors.