Features and outcome of differentiated thyroid carcinoma associated with Graves' disease: results of a large, retrospective, multicenter study
Features and outcome of differentiated thyroid carcinoma associated with Graves' disease: results of a large, retrospective, multicenter study
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DOI：
10.1007/s40618-019-01088-5
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发表时间：
2020-01-01
影响因子：
5.4
通讯作者：
Bartalena, L.
中科院分区：
文献类型：
--
作者：
Premoli, P.;Tanda, M. L.;Bartalena, L.
背景分化型甲状腺癌（DTC）伴发Graves病（GD）是否更具侵袭性且预后不佳仍有争议。目的通过多中心回顾性研究，比较DTC伴GD（DTC/GD+）和不伴GD（DTC/GD-）患者的基线特征和预后。本研究入组的患者为2005年至2014年期间转诊至5个内分泌单位（卡利亚里、帕维亚、比萨、锡耶纳和瓦雷塞）的579例患者：193例患者为DTC/GD+，386例DTC/GD-。患者的年龄、性别和肿瘤大小相匹配。他们因恶性肿瘤、甲状腺肿大或GD甲状腺功能亢进复发而接受手术。结果两组的基线DTC特征（组织学、淋巴结转移、甲状腺外侵犯）无差异，但多灶性在DTC/GD+组中明显更常见（27.5% vs. 7.5%，p < 0.0001）。在随访结束时（中位数7.5年），86%的DTC/GD+和89.6%的DTC/GD-患者无疾病。持续或复发性疾病（PRD）患者在大多数情况下有“生化疾病”。微小癌在DTC/GD+组中更常见（60% vs. 37%，p < 0.0001），并且具有极好的结局，两组之间的PRD没有差异。然而，在>= 1 cm的癌中，PRD在DTC/GD+中明显更常见（24.4%对11.5%; p = 0.005）。在整个组中，单变量和多变量分析显示GD+、淋巴结受累、甲状腺外浸润、多灶性和高细胞组织型与预后较差相关。女性和微小癌是有利的特征。未发现基线TSH受体抗体水平与结局之间存在关联。Graves' orbitopathy（GO）似乎与DTC的更好结局相关，可能是因为GO患者可能早期接受甲状腺功能亢进手术。结论GD仅在肿瘤>= 1cm时可能与并存DTC的不良预后相关，而微小癌的临床预后与GD的存在/不存在无关。
Background Whether differentiated thyroid cancer (DTC) occurring concomitantly with Graves' disease (GD) is more aggressive and bound to a less favorable outcome is controversial. Objective Aim of this multicenter retrospective study was to compare baseline features and outcome of DTC patients with GD (DTC/GD+) or without GD (DTC/GD-). Patients Enrolled in this study were 579 patients referred to five endocrine units (Cagliari, Pavia, Pisa, Siena, and Varese) between 2005 and 2014: 193 patients had DTC/GD+ , 386 DTC/GD-. Patients were matched for age, gender and tumor size. They underwent surgery because of malignancy, large goiter size, or relapse of hyperthyroidism in GD. Results Baseline DTC features (histology, lymph node metastases, extrathyroidal extension) did not differ in the two groups, except for multifocality which was significantly more frequent in DTC/GD+ (27.5% vs. 7.5%, p < 0.0001). At the end of follow-up (median 7.5 years), 86% of DTC/GD+ and 89.6% DTC/GD- patients were free of disease. Patients with persistent or recurrent disease (PRD) had "biochemical disease" in the majority of cases. Microcarcinomas were more frequent in the DTC/GD+ group (60% vs. 37%, p < 0.0001) and had an excellent outcome, with no difference in PRD between groups. However, in carcinomas >= 1 cm, PRD was significantly more common in DTC/GD+ (24.4% vs. 11.5%; p = 0.005). In the whole group, univariate and multivariate analyses showed that GD+ , lymph node involvement, extrathyroidal invasion, multifocality and tall cell histotype were associated with a worse outcome. Female gender and microcarcinomas were favorable features. No association was found between baseline TSH-receptor antibody levels and outcome. Graves' orbitopathy (GO) seemed to be associated with a better outcome of DTC, possibly because patients with GO may early undergo surgery for hyperthyroidism. Conclusions GD may be associated with a worse outcome of coexisting DTC only if cancer is >= 1 cm, whereas clinical outcome of microcarcinomas is not related to the presence/absence of GD.