目的: 分析桥本甲状腺炎（Hashimoto′s thyroiditis, HT）对甲状腺乳头状癌（papillary thyroid carcinoma, PTC）临床病理学特性的影响。方法: 2014年1月至2016年12月间瑞金医院外科1 416例单侧PTC并行甲状腺全切除术的病人纳入研究。依据术前血清中甲状腺球蛋白抗体和甲状腺过氧化物酶抗体浓度,将病人分为PTC伴HT组（A组）和PTC不伴HT组（B组）。基于病理学检查,评估癌灶双腺叶累及、最大肿瘤直径、甲状腺包膜浸润、多灶性和中央组淋巴结转移。结果: 31.78%（450/1 416）的病人为PTC伴HT。A组双腺叶PTC累及比例（53.78%）显著高于B组（42.34%,P<0.001）,且多癌灶的比例（28.22%）也显著高于B组（22.77%,P=0.027）。A组病人微小癌（直径<1 cm）比例（51.11%）也显著高于B组（44.51%,P=0.020）。但A组病人包膜侵犯率（6.89%）显著低于B组（10.77%,P=0.021）。在中央组淋巴结转移方面,两组无统计学差异。结论: 伴HT的PTC更易发生双腺叶癌累及和多灶癌,因此建议这类病人行全甲状腺切除术,以避免手术范围不足所引起的残留风险。
Objective To analyze the clinicopathological characteristics in the patients with papillary thyroid carcinoma (PTC) and Hashimoto′s thyroiditis(HT). Methods A total of 1 416 patients with single lobe of PTC who underwent total thyroidectomy in Department of Surgery Ruijin Hospital were included in this study from January 2014 to December 2016. According to the preoperative concentration of thyroid globulin antibody and thyroid peroxidase antibody in serum, the patients were divided into group of PTC with HT (group A) and group of PTC without HT (group B). Based on the postoperative pathological examination, the patients were evaluated bilateral thyroid cancer involvement, tumor size, invasion of thyroid capsule, multifocality and central lymph node metastasis. Results There were 31.78% (450/1 416) patients with PTC and HT. The patients with contralateral PTC in group A was 53.78% and 42.34% in group B with statistical difference (P<; 0.001). Multifocality was 28.22% in group A and 22.77% in group B (P=0.027). Microcarcinoma (diameter<; 1 cm) was 51.11% in group A higher than that in group B (44.51%) significantly (P=0.020). However, invasion of thyroid capsule was lower in group A than that in group B (6.89% vs 10.77%) (P=0.021). There was no significant difference in central lymph node metastasis between two groups. Conclusions In patients with PTC and HT, tumor might be more likely bilaterally involved and multifocal and total thyroidectomy should be recommended to avoid residual cancer due to insufficient surgical resection.
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