【作者】 李惠；

【导师】 嵇庆海；

【作者基本信息】 复旦大学 ， 肿瘤学， 2012， 硕士

【摘要】 目的研究桥本甲状腺炎(HT,hashimoto’s thyroiditis)合并乳头状甲状腺癌(PTC, papillary thyroid cancer)的临床病理特点,探讨桥本甲状腺炎与乳头状甲状腺癌两者之间的关系,以便临床更好地鉴别此类病人、早期对其进行干预,使其获得良好的预后。资料和方法回顾分析2008年01月01日至2011年01月01日间,复旦大学附属肿瘤医院头颈外科收治的6109例甲状腺疾病患者临床的病理资料(所有患者均有术后病理诊断),根据病理诊断：乳头状甲状腺癌、桥本甲状腺炎、甲状腺良性肿瘤(包括甲状腺结节肿及甲状腺腺瘤)进行分组,对比各组之间在年龄、性别、大小结节、原发肿瘤外侵、中央区淋巴结转移和血清促甲状腺激素(TSH, thyroid-stimulating hormone)水平等方面是否存在差异。结果符合入组条件的6109例甲状腺疾病患者中,有653例患者诊断为桥本甲状腺炎。桥本甲状腺炎患者中乳头状甲状腺癌的比例(381/653,58.3%)明显高于非桥本甲状腺炎患者中乳头状癌的比例(2440/5456,44.7%,p<0.05)。对病例资料完整的5115例甲状腺疾病患者进行研究,发现在乳头状甲状腺癌患者中,合并桥本甲状腺炎的患者与不合并桥本甲状腺炎的患者相比发病年龄轻,女性比例高,结节直径小,拥有较高TSH水平。单因素分析表明桥本甲状腺炎和高水平的TSH为甲状腺结节诊断为乳头状甲状腺癌的危险因素,而多因素分析结果显示,桥本甲状腺炎为其保护因素。在乳头状甲状腺癌患者中桥本甲状腺炎为中央区淋巴结转移的保护因素,中央区淋巴结转移在合并桥本甲状腺炎的乳头状甲状腺癌与单纯乳头状甲状腺癌两组间的差异有统计学意义(P<0.05)；中央区淋巴结转移在合并桥本甲状腺炎的甲状腺乳头状癌与合并良性结节的甲状腺乳头状癌两组间的差异有统计学意义(P<0.05)。结论乳头状甲状腺癌和桥本甲状腺炎之间有一定的临床关联,二者之间有着相似的流行病学特征,但二者之间是否存在因果关系有待进一步研究。桥本甲状腺炎作为一种自身免疫性疾病,其炎性微环境中的免疫反应即可为乳头状甲状腺癌的诱因,又可对乳头状甲状腺癌的进展起抑制作用,成为甲状腺乳头状癌的保护因素。桥本甲状腺炎中乳头状甲状腺癌的比例明显高于一般人群,桥本甲状腺炎合并乳头状甲状腺癌的患者的TSH水平明显高于桥本甲状腺合并良性结节患者的TSH水平。TSH作为生长因子,在正常情况下调节甲状腺细胞的增生及功能稳定,而病理状态下,高水平的TSH可能是促进甲状腺癌形成和进展的主要因素。更多还原

【Abstract】 Objective:To identify the clinicopathological factors of co-existing papillary thyroid cancer (PTC) in patients with Hashimoto’s thyroiditis (HT) and provide information to aid in the diagnosis and treatment of such patients.Methods:This study included6109patients treated in a university-based tertiary care cancer hospital over a3-year period. All the patients were categorized based on their final diagnosis. Several clinicopathological factors, such as age, gender, nodular size, invasive status, central compartment lymph node metastasis (CLNM) and serum TSH level, were compared between the various groups of patients.Results:In sum, there were653patients with a final diagnosis of HT. More PTC were found in those with HT (381out of653or58.3%) than in those without HT (2440out of5456or44.7%, p<0.05). The HT patients with co-occurring PTC were more likely to be younger, female, had smaller nodules and had higher TSH levels than those without PTC. A univariate analysis demonstrated that the presence of HT and higher TSH levels were risk factors for a diagnosis of PTC, while a multivariate analysis suggested that the presence of higher TSH levels was risk factors for a diagnosis of PTC, while the presence of HT had a protective role against PTC. In the PTC patients, moreover, the presence of HT or other benign nodule was a protective factor for CLNM, while the TSH level had no significant associations.Conclusion:PTC and HT have a close relationship, and have similar epidemiological characteristics. The HT patients with co-occurring PTC are more likely to be younger, female, smaller nodules and higher TSH levels than those without PTC, and also they have lower rates of invasion of the primary tumor and lymph node metastasis. From the results of our study, we hypothesize that HT is the risk factor for the transformation of thyroid cancer. And the elevated serum TSH caused by long-term HT may be the real risk factor for the formation and progress of thyroid cancer. Furthermore, the disease’s invasiveness and metastasis in patients suffering from both PTC and HT could be used as a model in research investigating inflammation and cancer progression.更多还原