慢性淋巴细胞性甲状腺炎对分化型甲状腺癌放射性碘清甲治疗效果的影响
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摘要
背景与目的:慢性淋巴细胞性甲状腺炎(chronic lymphocytic thyroiditis,CLT)是常见的甲状腺自身免疫炎性反应,本研究探讨其对分化型甲状腺癌(differentiated thyroid cancer,DTC)放射性碘-131(~(131)I)治疗效果的影响。方法:回顾性分析了2014—2016年就诊于北京协和医院的中低危DTC患者128例,根据术后病理学检查是否伴CLT分为CLT1组与CLT0组。采用卡方检验、秩和检验等对比两组患者一般临床病理特征,依据2015版美国甲状腺协会(American Thyroid Association)效果反应体系对两组患者~(131)I治疗的治疗反应进行评价,并对CLT与~(131)I治疗效果进行相关性分析,探讨CLT对~(131)I治疗效果及预后的影响。结果:CLT1组原发灶较小(P=0.028)且女性多见(P=0.011),而在年龄、多灶性、淋巴结分期、被膜外侵犯及TNM分期方面,差异无统计学意义(P>0.05)。CLT1组与CLT0组患者131I治疗后疗效满意、疗效不确定、血清学疗效不满意、结构性疗效不满意率分别为72.7%(40/55)vs 68.5%(50/73)、14.5%(8/55)vs 13.7%(10/73)、3.6%(2/55)vs 6.8%(5/73)和9.1%(5/55)vs 10.9%(8/73),对比分析提示两组间治疗效果与短期预后未见明显差异。相关性分析显示CLT与治疗效果不相关(P=0.519)。结论:CLT不是影响DTC患者131I治疗效果及预后的因素。
Background and purpose: Chronic lymphocytic thyroiditis(CLT) is a common autoimmune inflammation. The aim of this present study was to determine the relationship between CLT and the response of patients with differentiated thyroid carcinoma(DTC) who received surgery and radioactive iodine(~(131)I) treatment for thyroid carcinoma. Methods: We retrospectively analyzed 128 patients who received initial treatment for thyroid disease at Peking Union Medical College Hospital from 2014 to 2016. Data of the participants with histologically confirmed DTC were analysed according to the presence(CLT1) or absence(CLT0) of concurrent CLT. One-way analysis, chi-square test and rank-sum test, Mann-Whitney test and multivariate analyses were used to evaluate the clinicopathological features. Correlation analysis was conducted between response to ~(131)I and the presence or absence of concurrent CLT. The response was evaluated between two groups according to 2015 American Thyroid Association(ATA) response system. Results: Of the 128 patients, smaller tumor size and a greater female preponderance were noted in the patients with CLT compared with those without CLT(P=0.028, P=0.011, respectively). There was no significant difference inage, multifocality, stages of lymph nodes, capsular invasion and TNM classification system between the groups for DTC during 24-month mean follow-up period. There was no significant difference in response between two groups. The excellent response(ER) was 72.7%(40/55) and 68.5%(50/73), respectively. Indeterminate response(IR) was 14.5%(8/55) and 13.7%(10/73), respectively. Biochemical incomplete response(BIR) was 3.6%(2/55) and 6.8%(5/73), respectively. Structural incomplete response(SIR) was 9.1%(5/55) and 10.9%(8/73), respectively. Meanwhile, there was no correlation between response and the presence or absence of CTL(P=0.519). Conclusion: Our results do not support the hypothesis that CLT is associated with the response to ~(131)I treatment for DTC patients.
Background and purpose: Chronic lymphocytic thyroiditis(CLT) is a common autoimmune inflammation. The aim of this present study was to determine the relationship between CLT and the response of patients with differentiated thyroid carcinoma(DTC) who received surgery and radioactive iodine(~(131)I) treatment for thyroid carcinoma. Methods: We retrospectively analyzed 128 patients who received initial treatment for thyroid disease at Peking Union Medical College Hospital from 2014 to 2016. Data of the participants with histologically confirmed DTC were analysed according to the presence(CLT1) or absence(CLT0) of concurrent CLT. One-way analysis, chi-square test and rank-sum test, Mann-Whitney test and multivariate analyses were used to evaluate the clinicopathological features. Correlation analysis was conducted between response to ~(131)I and the presence or absence of concurrent CLT. The response was evaluated between two groups according to 2015 American Thyroid Association(ATA) response system. Results: Of the 128 patients, smaller tumor size and a greater female preponderance were noted in the patients with CLT compared with those without CLT(P=0.028, P=0.011, respectively). There was no significant difference inage, multifocality, stages of lymph nodes, capsular invasion and TNM classification system between the groups for DTC during 24-month mean follow-up period. There was no significant difference in response between two groups. The excellent response(ER) was 72.7%(40/55) and 68.5%(50/73), respectively. Indeterminate response(IR) was 14.5%(8/55) and 13.7%(10/73), respectively. Biochemical incomplete response(BIR) was 3.6%(2/55) and 6.8%(5/73), respectively. Structural incomplete response(SIR) was 9.1%(5/55) and 10.9%(8/73), respectively. Meanwhile, there was no correlation between response and the presence or absence of CTL(P=0.519). Conclusion: Our results do not support the hypothesis that CLT is associated with the response to ~(131)I treatment for DTC patients.
引文
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[22]李惠.桥本甲状腺炎合并乳头状甲状腺癌的临床病理特征[D].复旦大学,2012.
[23]KIM M,KIM W G,OH H S,et al.Comparison of the 7th and 8th editions of the AJCC/UICC TNM staging system for differentiated thyroid cancer[J].Thyroid,2017.doi:10.1089/thy.2017.0050
[2]FERLAY J,BRAY F,PISANI P,et al.Cancer incidence,mortality and prevalence worldwide[M].Lyon:LARC Press,2001.
[3]NIX P,NICOLAIDES A,COATESWORTH A P.Thyroid cancer review 1:presentation and investigation of thyroid cancer[J].Int J Clin Pract,2005,59(11):1340-1344.
[4]LARSON S D,JACKSON L N,RIALL T S,et al.Increased incidence of well-differentiated thyroid cancer associated with Hashimoto thyroiditis and the role of the PI3k/Akt pathway[J].J Am Coll Surg,2007,204(5):764-773;discussion 773-775.
[5]AHN D,HEO S J,PARK J H,et al.Clinical relationship between Hashimoto's thyroiditis and papillary thyroid cancer[J].Acta Oncol,2011,50(8):1228-1234.
[6]DAILEY M E,LINDSAY S,SKAHEN R.Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland[J].AMA Arch Surg,1955,70(2):291-297.
[7]FELDT-RASMUSSEN U,RASMUSSEN A K.Autoimmunity in differentiated thyroid cancer:significance and related clinical problems[J].Hormones(Athens),2010,9(2):109-117.
[8]TENG W,SHAN Z,TENG X,et al.Effect of iodine intake on thyroid diseases in China[J].N Engl J Med,2006,354(26):2783-2793.
[9]JEMAL A,SIEGEL R,WARD E,et al.Cancer statistics[J].CA Cancer J Clin,2006,56(2):106-130.
[10]SINGH B,SHAHA A R,TRIVEDI H,et al.Coexistent Hashimoto’s thyroiditis with papillary thyroid carcinoma:impact on presentation,management,and outcome[J].Surgery,1999,126(6):1070-1076;discussion 1076-1077.
[11]OTT R A,MCHENRY C,JAROSZ H,et al.The incidence of thyroid carcinoma in Hashimoto’s thyroiditis[J].Am Surg,1987,53(8):442-445.
[12]HIRABAYASHI R N,LINDSAY S.The relation of thyroid carcinoma and chronic thyroiditis[J].Surg Gynecol Obstet,1965,121:243-252.
[13]梁军,赵丹,梁智勇,等.甲状腺乳头状癌合并淋巴细胞性甲状腺炎临床病理生物学特征分析[J].中华肿瘤防治杂志,2013,20(17):1331-1335
[14]王光杰,陈晓东.慢性淋巴细胞性甲状腺炎合并甲状腺恶性肿瘤的诊治[J].当代医学,2008,14(23):72-73.
[15]LOH K C,GREENSPAN S F,DONG F,et al.Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma[J].J Clin Endocrinol Metab,1999,84(2):458-463.
[16]HUANG B Y,HSEUH C,CHAO T C,et al.Well-differentiated thyroid carcinoma with concomitant Hashimoto's thyroiditis present with less aggressive clinical stage and low recurrence[J].Endocr Pathol,2011,22(3):144-149.
[17]AHN D,HEO S J,PARK J H,et al.Clinical relationship between Hashimoto's thyroiditis and papillary thyroid cancer[J].Acta Oncol,2011,50(8):1228-1234.
[18]DERWAHL M,NICULA D.Estrogen and its role in thyroid cancer[J].Endocr Relat Cancer,2014,21(5):273-283
[19]MANOLE D,SCHILDKNECHT B,GOSNELL B,et al.Estrogen promotes growth of human thyroid tumor cells by different molecular mechanisms[J].J Clin Endocrinol Metab,2001,86(3):1072-1077.
[20]朱国华.21例桥本氏病合并甲状腺癌诊疗分析[J].中国慢性病预防与控制,2007,15(3):260.
[21]KIM S K,SONG K H,LIM S D,et al.Clinical and pathological features and the BRAF(V600E)mutation in patients with papillary thyroid carcinoma with and without concurrent Hashimoto thyroiditis[J].Thyroid,2009,19(2):137-141
[22]李惠.桥本甲状腺炎合并乳头状甲状腺癌的临床病理特征[D].复旦大学,2012.
[23]KIM M,KIM W G,OH H S,et al.Comparison of the 7th and 8th editions of the AJCC/UICC TNM staging system for differentiated thyroid cancer[J].Thyroid,2017.doi:10.1089/thy.2017.0050