合并桥本氏甲状腺炎对甲状腺乳头状癌临床侵袭性影响的回顾性分析

Retrospective analysis of the influence of hashimoto thyroiditis on clinical invasiveness of papillary thyroid carcinoma

目的探讨患者的临床病理特征对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)侵袭性的影响,尤其是合并桥本氏甲状腺炎(Hashimoto’s thyroiditis,HT)对PTC侵袭性的影响。方法回顾性分析昆明医科大学第一附属医院甲状腺疾病诊治中心2012年4月至2018年12月收治的5018例PTC患者的病历资料,其中因资料不全166例、家族史394例、合并甲亢等其他甲状腺疾病55例、合并其他恶性肿瘤史或有放化疗史39例、血清TSH异常(降低或升高)548例被排除,筛选后共有3816例纳入此次研究。观察指标包含性别、年龄、肿瘤大小、腺外浸润、脉管侵犯、有无HT及血清TSH水平,通过对肿瘤腺外浸润及肿瘤尺寸的统计学分析来预测PTC的侵袭性。本次研究采用SPSS 23.0统计软件进行分析,单因素分析采用非参数检验(χ^(2)检验和秩和检验);多因素分析采用Logistic回归和线性回归分析,均以P<0.05为差异有统计学意义。结果本研究通过PTC多因素Logistic回归分析,结果显示,肿瘤大小[β=0.696,P<0.001,OR(95%CI)=2.006(1.827~2.204)]、脉管侵犯[β=0.772,P<0.001,OR(95%CI)=2.165(1.546~3.031)]、HT[β=-0.303,P=0.006,OR(95%CI)=0.739(0.596~0.915)]对腺外浸润均有独立影响作用。肿瘤大小的线性回归分析结果显示,性别(β=0.082,P<0.001)、年龄(β=-0.134,P<0.001)、腺外浸润(β=0.268,P<0.001)、脉管侵犯(β=0.076,P<0.001)对肿瘤大小均是独立影响因素。结论肿瘤尺寸较大和存在脉管侵犯是PTC腺外浸润的独立危险因素,合并HT是其保护因素;男性、年龄≤45岁、存在腺外浸润和脉管侵犯是PTC肿瘤大小的独立危险因素。是否合并HT对PTC腺外浸润的作用有差异,其临床意义和机制还有待进一步研究。

Objective To explore the impact of the clinicopathological characteristics of patients on the invasiveness of thyroid papillary carcinoma,especially the impact of Hashimoto’s thyroiditis.Methods A retrospective analysis of the medical records of 5,018 patients with papillary thyroid carcinoma who were admitted to the Center for Thyroid Diseases of the First Affiliated Hospital of Kunming Medical University from Apr.2012 to Dec.2018 was conducted.Among them,166 cases were excluded due to incomplete data,394 cases with family history,55 cases with hyperthyroidism or other thyroid diseases,39 cases with other malignant tumors or history of radiotherapy and chemotherapy,and 548 cases with abnormal serum TSH(decreased or increased).After screening,a total of 3816 cases were included in this study.Observation indicators included gender,age,tumor size,extraglandular invasion,vascular invasion,Hashimoto and serum TSH levels.The serum TSH results of the 3816 patients included in this study were all normal.The invasiveness of PTC was predicted by statistical analysis of tumor extraglandular infiltration and tumor size.The study used SPSS 23.0 statistical software for analysis,univariate analysis was made by non-parametric tests(χ^(2) test and rank sum test),multivariate analysis was made by Logistic regression and linear regression analysis,and the differences were statistically significant at P<0.05.Results Multivariate logistic regression analysis showed that tumor size[β=0.696,P<0.001,OR(95%CI)=2.006(1.827-2.204)],vascular invasion[β=0.772,P<0.001,OR(95%CI)=2.165(1.546-3.031)],Hashimoto[β=-0.303,P=0.006,OR(95%CI)=0.739(0.596-0.915)]had an independent effect on extraglandular infiltration.The results of linear regression analysis of tumor size showed that gender(β=0.082,P<0.001),age(β=-0.134,P<0.001),extraglandular infiltration(β=0.268,P<0.001),vascular invasion(β=0.076,P<0.001)were independent influencing factors for tumor size.Conclusions Lage tumor size and the presence of vascular invasion are independent risk factors for extraglandular invasion of PTC,and HT is protective factor.Male,age≤45 years old,presence of extraglandular invasion and vascular invasion are independent risk factors for tumor size of PTC.The clinical significance and mechanism of the difference in the effect of Hashimoto’s thyroiditis on the extra-gland infiltration of thyroid papillary carcinoma remains to be further studied.