【摘要】 目的 通过研究分析甲状腺乳头状癌（PTC）分别合并桥本氏甲状腺炎（HT）、结节性甲状腺肿（NG）、甲状腺腺瘤（TA）和单纯PTC共4组的临床病理特征及术后复发风险以提高对甲状腺乳头状癌的认识。方法 选取2019年1月1日至2020年12月31日在重庆医科大学附属第二医院行外科手术治疗的PTC患者657例，对比分析单纯PTC组（对照组）、HT+PTC组（组1）、NG+PTC组（组2）、TA+PTC组（组3）共4组间临床病理与预后差异。结果 （1）性别与年龄及病理特征：组2与组3较对照组发病年龄偏大；组1与组2较对照组女性发病例数更多；组3较对照组发生多灶癌的概率更多；组2较对照组发生淋巴结转移的概率更小。（2）甲状腺功能：组3较对照组TSH水平偏低；组1与组2较对照组FT3水平均偏低；组1较对照组甲状腺球蛋白抗体（TGAB）、甲状腺过氧化物酶抗体（TPOAB）水平更高。（3）TNM分期与AJCC分期：组2较对照组N0患者占比更多；组3较对照组1期患者占比更少，2期患者占比更多。（4）复发风险分层与MACIS预后评分：组2及组3较对照组低危患者占比更多；组3较对照组20年生存率更低。差异均有统计学意义（P <0.05）。结论 PTC合并其他良性疾病时与单纯PTC患者的临床病理特征存在明显差异，提示治疗方案需个性化定制。合并甲状腺良性病变的患者应密切随访，早期诊断、适时恰当的手术治疗是提高患者生存率及改善预后的关键。更多还原

【Abstract】 Objective To improve the understanding of papillary thyroid carcinoma(PTC)by analyze the clinicopathological features and postoperative recurrence risk of four groups including PTC and PTC with Hashimoto′s thyroiditis(HT),PTC with Nodular goiter(NG),PTC with Thyroid adenoma(TA)respectively.Methods A total of 657 patients with PTC were selected to compare and analyze the differences in clinicopathology and prognosis among the four groups of pure PTC(the control group),HT+PTC(group 1),NG+PTC(group 2),TA+PTC(group 3).Results （1）Gender,age and pathological characteristics:the age of onset in group 2 and group 3 was older than that in the control group;group 1 and group 2 had more female cases than the control group;the incidence of multifocal carcinoma was higher in group 3 than that in the control group;group 2 was less likely to have lymph node metastasis than the control group.(2)Thyroid function:TSH levels in group 3 was lower than that in the control group;FT3 levels in group 1 and group 2 were lower than those in the control group;and TGAB and TPOAB levels in group 1 were higher than those in the control group.(3)TNM staging and AJCC staging:group 2 had a larger proportion of N0 patients than the control group;group 3 had a smaller proportion of stage 1 patients and a larger proportion of stage 2 patients than the control group.(4)Recurrence risk stratification and MACIS prognostic score:groups 2 and group 3 accounted for a larger proportion of low-risk patients than the control group;group 3 had a lower 20-year survival rate than the control group.The above results were statistically significant(P<0.05).Conclusion The clinical and pathological characteristics of patients with PTC combined with other benign diseases are significantly different from pure PTC patients,suggesting that the treatment plan needs to be customized.Patients with benign thyroid disease should be closely followed up.Early diagnosis and timely and appropriate surgical treatment are the keys to improving survival and prognosis.更多还原