甲状腺乳头状癌伴桥本氏甲状腺炎的病理特征分析

A retrospective analysis of pathological features of papillary thyroid 1 carcinoma with Hashimoto's thyroiditis

目的分析对比单纯甲状腺乳头状癌(papillary thyroid carcinoma,PTC)与PTC合并桥本氏甲状腺炎(Hashimoto's thyroiditis,HT)患者的病理资料特点,为临床提供治疗思路。方法回顾性分析2020年1月至2022年5月南京市中医院甲乳外科住院并行手术治疗的326例符合要求的PTC患者病历资料,男81例,女245例,根据是否合并HT分为PTC组和HT-PTC组。收集患者指标包括患者性别、年龄、体质指数(bodymass index,BMI)、术前甲功五项包括游离三碘甲状腺原氨酸(free triodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4),三碘甲状腺原氨酸(triodothyronine,T3),甲状腺素(thyroxine,T4)、促甲状腺激素(thy-roid stimulating hormone,TSH)、BRAF基因突变情况、病灶单双侧、病灶单灶或多灶、术后病理肿瘤病灶最大径、颈部淋巴结转移(lymph node metastasis,LNM)情况等;同时将所有患者按照CLNM情况分为CLNM组和无CLNM组,比较两组性别、年龄≥55岁、是否合并HT、病灶数、病灶单双侧、腺体外侵犯、是否微小癌及BRAF基因等差异。使用统计学软件对结果进行分析,采用t检验、χ^(2)检验、Logistic回归分析,P<0.05表示差异具有统计学意义。结果两组女性患者占比均较高,且HT-PTC组女性占比率为90%(90/100),高于PTC组的68.58%(155/226),HT-PTC患者年龄低于PTC组患者(43.03±12.72vs.43.70±12.63)岁,TSH(2.71±1.69比2.02±1.46)uIU/mL更高,差异均具有统计学意义(均P<0.05),而BMI、FT3、FT4、T3、T4差异均无统计学意义(均P>0.05)。HT-PTC组BRAF基因突变比例更低[87.00%(87/100)vs.93.81%(212/226)],肿瘤最大径更小(1.06±0.73vs.1.32±0.97)cm,CLNM比例更低[37.00%(37/100)vs.52.21%(118/226)],伴有转移时LNM数少(3.33±2.21vs.4.76±4.00)个,但更易表现为多灶性[44.00%(44/100)us.32.30%(73/226)],差异均具有统计学意义(均P<0.05),而累及双侧腺叶、腺体外侵犯差异不具有统计学意义。伴有CLNM时,性别(男vs.女)[35.45%/64.52%(55/100)vs.15.2%/84.85%(26/145)]、年龄≥55岁(是vs.否)[13.55%/86.45%(21/134)us.29.24%/70.76%(50/121)]、伴随HT(是vs.否)[23.87%/76.13%(37/118)us.36.84%/63.16%(63/108)]、病灶数(单灶vs.多灶)[50.06%/41.94%(90/65)vs.69.59%/30.41%(119/52)]、微小癌(是us.否)[53.55%/45.45%(83/72)vs.81.29%/18.71%(139/32)]及腺体外侵犯(有vs.无)[24.52%/75.48%(38/117)vs.17.42%/84.21%(27/144)]差异均有统计学意义(均P<0.05),病灶累及双侧及BRAF基因突变情况差异无统计学意义(均P>0.05)。多因素Logistic回归分析显示年龄、微小癌、HT、性别、病灶数是CLNM的独立危险因素,且男性、多灶癌是CLNM的危险因素,年龄≥55岁、微小癌和合并HT与CLNM呈负相关。结论HT可能促进PTC的发生,但能抑制其发展,在短期内伴随HT患者较单纯PTC患者可获得更好的预后。

ObjectiveTo analyze and compare the pathological data characteristics of patients with sim-ple papillary thyroid carcinoma(PTC)and PTC combined with Hashimoto's thyroiditis(HT),so as to provide clinical treatment ideas.Methods A retrospective analysis was performed on the medical records of 326 PTC pa-tients who met the requirements and underwent surgical treatment in the Department of Thyroid and Breast Sur-gery,Nanjing Hospital of Traditional Chinese Medicine from Jan.2020 to May.2022.There were 81 males and 245 females.They were divided into PTC group and HT-PTC group,according to whether they were combined with HT.Clinical data were collected and organized.The collection indicators included patient gender,age,body mass index(BMI),five preoperative thyroid function items including free triodothyronine(FT3),free thyroxine(FT4),triodothyronine(T3),thyroxine(T4),thyroid stimulating hormone(TSH),BRAF gene mutation,single or bilateral lesions,single or multiple lesions,largest postoperative pathological tumor lesions diameter,cervical lymph node metastasis(LNM)status,etc.At the same time,all patients were divided into CLNM group and no CLNM group according to CLNM status.The two groups were compared in terms of gender,age≥55 years old,whether combined with HT,number of lesions,unilateral and bilateral,extraglandular invasion,microcarcinoma,and BRAF gene.Statistical software was used to analyze the results.t test,χ^(2)test,and logistic regression analysis were adopted.P<0.05 indicates that the difference is statistically significant.Results The proportion of female patients in both groups was higher,and the proportion of female patients in the HT-PTC group(90/100,90%)was higher than that in the PTC group(155/226,69.59%).HT-PTC patients were younger than patients in the PTC group(43.03±12.72 us.43.70±12.63)years old,and their TSH(2.71±1.69 vs.2.02±1.46)ulU/mL was higher.The differences were statistically significant(all P<0.05).There were no statistically significant differences in BMI,FT3,FT4,T3,or T4(all P>0.05).The HT-PTC group had a lower proportion of BRAF gene mutations[87/100(87%)us.212/226(93.8%)],a smaller maximum tumor diameter(1.06±0.73 vs.1.32±0.97 cm),and a lower proportion of CLNM[37/100(37%)vs.118/226(52.2%)].The number of LNMs with metastasis is less(3.33±2.21 vs.4.76±4.00),and it was more likely to be multifocal[44/100(44%)us.73/226(32.74%)].All differences were statistically significant(all P<0.05),and the differences in bilateral gland lobes involvement and extra-glandular invasion were not statistically significant.When accompanied by CLNM,gender(male vs.female)[55/100(35.45%/64.52%)us.26/145(15.2%/84.85%)],age≥55 years(yes vs.no)[21/134(13.55)%/86.45%)us.50/121(29.24%/70.76%)],HT(yes us.no)[37/118(23.87%/76.13%)vs.63/108(36.84%/63.16%),number of lesions(single focus vs.multiple focus)][90/65(41.94%/50.06%)vs.119/52(69.59%/30.41%)],microcarcinoma(yes us.no)[83/72(53.55%/45.45%)vs.139/32(81.29%/18.71%)]and extraglandular invasion(with vs.without)[38/117(24.52%/75.48%)us.27/144(17.42%/84.21%)]had statistics significance(both P<0.05).There was no statistical significance in bilateral lesion involvement or BRAF gene mutation(all P>0.05).Multivariate logistic regression analysis showed that age,microcarcinoma,HT,gender,and number of lesions were independent risk factors for CLNM,and male gender and multifocal cancer were risk factors for CLNM.Age≥55 years,microcarcinoma,and combined HT were negatively associated with CLNM.Conclusions HT may promote the occurrence of PTC,but can inhibit its development.In the short term,patients with HT can have a better prognosis than those with simple PTC.