INCREASED AGGRESSIVENESS OF THYROID-CANCER IN PATIENTS WITH GRAVES-DISEASE
INCREASED AGGRESSIVENESS OF THYROID-CANCER IN PATIENTS WITH GRAVES-DISEASE
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DOI：
10.1210/jcem-70-4-830
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发表时间：
1990-04-01
影响因子：
5.8
通讯作者：
VIGNERI, R
中科院分区：
文献类型：
--
作者：
BELFIORE, A;GAROFALO, MR;VIGNERI, R
为了评价Graves病是否影响甲状腺癌的预后，我们对22例分化型甲状腺癌合并甲状腺功能亢进的临床和病理特征进行了分析；13例合并Graves病，9例合并自主甲状腺结节。在连续的359例甲状腺功能亢进患者（132例Graves病患者和227例自主甲状腺结节患者）中发现癌，这些患者在6年期间接受了手术。在同期手术的582例甲状腺功能正常患者中发现137例甲状腺癌。Graves患者的多灶性（46.1% vs. 0%）、局部侵袭性（61.5% vs. 11.1%）、转移到淋巴结（61.5% vs. 11.1%）或远处转移（23.0% vs. 0%）的比例高于自主甲状腺结节患者。此外，伴有格雷夫斯病的癌更大（3.3 +-）。1.8 vs. 1.0。-0.7 cm)，且复发率高。在甲状腺功能正常的患者中，甲状腺癌的侵袭性为中等。所有甲状腺功能亢进的甲状腺癌患者血清TSH水平均受到抑制。然而，循环促甲状腺抗体在13例格雷夫斯病患者中有12例存在，但在自主甲状腺结节患者中不存在。因此，我们的研究表明，TSAB可能在Graves病患者甲状腺癌的高侵袭性中起作用，并表明应该对这一亚组患者进行有力的治疗。
To evaluate whether coexistence of Graves'' disease affects the prognosis of thyroid cancer we examined the clinical and pathological characteristics of 22 differentiated thyroid carcinomas concomitant with hyperthyroidism; 13 were associated with Graves'' disease, and 9 with autonomous thyroid nodules. Carcinomas were identified in a consecutive series of 359 hyperthyroid patients (132 with Graves'' disease and 227 with autonomous thyroid nodules) who underwent surgery during a 6-yr period. One hundred and thirty-seven thyroid carcinomas were found in the 582 euthyroid patients operated on in the same period. In Graves'' patients, carcinomas were more often multifocal (46.1% vs. 0%), locally invasive (61.5% vs. 11.1%), and metastatic to lymph nodes (61.5% vs. 11.1%) or to distant sites (23.0% vs. 0%) then in patients with autonomous thyroid nodules. In addition, carcinomas concomitant with Graves'' disease were larger (3.3 .+-. 1.8 vs. 1.0 .+-. -0.7 cm) than the ones associated with autonomous thyroid nodules and showed a high recurrrence rate. In euthyroid patients, aggressiveness of thyroid cancer was intermediate. Serum TSH levels were suppressed in all hyperthyroid patients with thyroid cancer. However, circulating thyroid-stimulating antibodies were present in 12 of 13 cancer patients with Graves'' disease, but were absent in patients with autonomous thyroid nodules. Our study suggests, therefore, that TSAB may play a role in determining the high aggressiveness of thyroid cancer in Graves'' disease patients and indicate that a vigorous treatment should be pursued in this subgroup of patients.