甲状腺乳头状癌合并桥本甲状腺炎的临床病理特征及淋巴结转移因素分析

Clinicopathological characteristics of coexisting papillary thyroid cancinoma and Hashimoto’s throidtis and its lymph node metastasis risk factors

目的探讨甲状腺乳头状癌(papillary thyroid carcinoma,PTC)合并桥本甲状腺炎(Hashimoto’s thyroiditis,HT)的临床病理特征、肿瘤免疫微环境类型及淋巴结转移的危险因素。方法收集HT伴PTC(HT+PTC)标本89例,应用免疫组化CD8染色进行肿瘤免疫微环境分型,α-SMA标记癌相关成纤维细胞(cancer-associated fibroblasts,CAF);采用ARMS-PCR进行BRAF V600E基因突变检测,分析HT+PTC临床病理特征、肿瘤免疫微环境类型、CAF增生与淋巴结转移的关系。结果HT+PTC患者BRAF V600E基因突变率为61.79%,低于无HT伴发PTC患者(71.66%)。单因素分析:HT+PTC患者淋巴结转移与患者年龄、肿瘤直径、CAF增生、肿瘤免疫微环境类型相关。Logistic多因素回归分析:患者年龄增大是HT+PTC淋巴结转移的保护性因素,肿瘤直径大、病灶数量多、肿瘤免疫微环境免疫排斥型是淋巴结转移的危险因素。结论对肿瘤直径>0.5 cm、发病年龄≤30岁、肿瘤免疫微环境免疫排斥型、多癌灶的HT+PTC患者,进行预防性的淋巴结清扫,可能减少肿瘤复发。

Purpose To analyze the clinicopathological characteristics and the immune microenvironment of patients with coexisting papillary thyroid carcinoma(PTC)and Hashimoto’s thyroiditis(HT),and to explore into the risk factors for lymph node metastasis.Methods The clinicopathological data of 89 HT+PTC cases were retrospectively reviewed,BRAF V600E gene was detected by ARMS-PCR,and CD8 immunohistochemical staining was used to classify tumor immune microenvironment.The tumor-associated fibroblasts(CAF)were labeled by α-SMA immunohistochemical staining.The relationship between clinicopathological characteristics of HT+PTC,tumor immune microenvironment type,CAF and lymph node metastasis were observed.Results The presence of BRAF V600E mutation was found in 89 patients with HT+PTC(61.79%),and in 801 patients without HT accounted for 71.66%.Univariable analysis found that lymph node metastasis of HT+PTC was related to the patient age,tumor size,CAF,and type of tumor immune microenvironment.Logistic regression found that age of onset was a protective factor for lymph node metastasis in patients with HT+PTC,and larger tumor diameter,higher number of lesions,and tumor immune microenvironment IE type were risk factors for lymph node metastasis.Conclusion For HT+PTC patients with tumor diameter of>0.5 cm,onset age≤30 years,tumor immunomicroenvironment IE type and multiple cancer foci,preventive lymph node dissection can significantly reduce tumor recurrence.