甲状腺乳头状癌与桥本甲状腺炎相关性的研究进展

Study of relationship between papillary thyroid carcinoma and Hashimoto thyroiditis

目的总结甲状腺乳头状癌(papillary thyroid carcinoma,PTC)与桥本甲状腺炎(Hashimoto thyroiditis,HT)相关性的研究进展。方法收集分析近年来国内外有关PTC与HT两种常见疾病相关性的研究报道,进行归纳总结。结果综合文献复习,并结合笔者的临床研究结果,PTC和HT确实存在着密切联系,或者说存在一定的因果关系。HT和PTC可能都来源于同样的胚胎干细胞,HT是一种异常免疫反应导致的常见自身免疫性甲状腺疾病,也许是PTC的癌前触发因素,同时淋巴细胞浸润可能在抗肿瘤中起到一定保护作用。RET染色体重排、RAS点突变、BRAF基因突变都可能激活丝裂原活化蛋白激酶(mitogen-activated protein kinase,MAPK)通路,尤其在伴有HT的PTC病例中,RET染色体重排更为常见。在PTC未来治疗尤其是晚期病例中,针对RET/RAS/BRAF/MAPK通路激活的选择性靶向治疗是具有前景的治疗手段。结论PTC与HT两者间的关系尚未完全明确。HT是PTC的潜在风险因素,反之伴有HT的PTC病例预后相对较好。更多的前瞻性研究将有助于进一步阐明两者间的相关性。

Objective To summarize the progress of research about the relationship between papillary thyroid carcinoma(PTC)and Hashimoto’s thyroiditis(HT).Method The relevant literatures at home and abroad in recent years about this topic were collected and analyzed.Results Comprehensive literature reviewed,combined with the author's clinical research results,PTC and HT were indeed closely related,or there was a certain causal link.HT and PTC might both come from the same embryonic stem cells.HT was an autoimmune thyroid disease caused by abnormal immune response,and might be a triggering factor of PTC.Meanwhile,lymphocyte infiltration might play a certain protective role in anti-tumor effect.RET chromosome rearrangement,RAS point mutation and BRAF gene mutation might activate mitogen-activated protein kinase(MAPK)pathway,especially in PTC cases with HT in which RET chromosome rearrangement was more common.In the future,selective targeted therapy aiming at the activation of RET/RAS/BRAF/MAPK pathway was a promising treatment especially in advanced PTC cases.Conclusions The correlation between PTC and HT is not fully clarified.HT is a potential risk factor for PTC but the cases of PTC with HT have a better prognosis.More prospective studies will help to further clarify the correlation between two diseases.