Does Clinical and Biochemical Thyroid Dysfunction Impact on Endometrial Cancer Survival Outcomes? A Prospective Database Study.
Does Clinical and Biochemical Thyroid Dysfunction Impact on Endometrial Cancer Survival Outcomes? A Prospective Database Study.
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DOI：
10.3390/cancers13215444
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发表时间：
2021-10-29
期刊：
影响因子：
5.2
通讯作者：
Crosbie EJ
中科院分区：
文献类型：
--
作者：
Barr CE;Njoku K;Hotchkies L;Ryan NAJ;Wan YL;Davies DA;Razvi S;Crosbie EJ
子宫内膜癌是高收入国家最常见的妇科癌症。大多数妇女被早期诊断，预后良好，但那些晚期或复发性疾病的结果很差。本研究的目的是确定临床或生化甲状腺功能障碍是否可能有助于子宫内膜癌诊断和治疗后的生存结局。我们分析了333名在专业癌症中心接受子宫内膜癌治疗的妇女的临床数据和血清甲状腺激素状态，并进行了中位数为35个月的随访。诊断为甲状腺功能减退症的女性与未诊断的女性相比，总体、癌症特异性和无复发生存率均有所改善。这可能对我们理解生物侵袭性疾病的机制具有重要意义，并为治疗干预提供了机会。子宫内膜癌是发达国家最常见的妇科恶性肿瘤，高危或晚期患者预后差。甲状腺激素在细胞代谢中起着关键作用，可以影响癌症的生长和侵袭。我们的目的是评估临床和生化甲状腺功能障碍与子宫内膜癌生存结局之间的关系。这是一项在专科中心接受子宫内膜癌治疗的妇女的前瞻性队列研究。甲状腺功能减退症的临床诊断是基于临床和生化评估，由全科医生（GP）的记录验证。检测治疗前血清样本的促甲状腺激素（TSH）、甲状腺激素（游离T4和总T3）和甲状腺过氧化物酶抗体。Kaplan-Meier生存率估计值和对数秩检验用于比较组间生存率，而考克斯回归用于多变量分析，调整已知混杂因素和效应修正。共纳入333名女性，中位年龄和体重指数（BMI）分别为66岁（四分位距（IQR）56，73）和33 kg/m2（IQR 27，41）。共有51名（15.3%）妇女被诊断为甲状腺功能减退症，39名（11.9%）有明显或亚临床甲状腺功能减退症的生化证据。中位随访时间为35个月（IQR 21，45），38例（11.7%）复发，50例（15.0%）死亡。诊断为甲状腺功能减退症的妇女的总生存率提高（校正HR = 0.22，95%CI 0.06-0.74，p = 0.02），癌症特异性生存期（校正HR = 0.21，95%CI 0.05-0.98，p = 0.04）和复发率（校正HR = 0.17，95%CI 0.04-0.77，p = 0.02）。验证性研究应探索潜在的机制和治疗开发的潜力。
Endometrial cancer is the most common gynaecological cancer in high-income countries. Most women are diagnosed early and have an excellent prognosis, but those with advanced or recurrent disease have poor outcomes. The aim of this study was to determine whether clinical or biochemical thyroid dysfunction may contribute to survival outcomes following diagnosis and treatment for endometrial cancer. We analysed clinical data and serum thyroid hormone status of 333 women treated for endometrial cancer at a specialist cancer centre and followed up for a median of 35 months. Women with a diagnosis of hypothyroidism had improved overall, cancer-specific, and recurrence-free survival compared to those without. This may have important implications for our understanding of the mechanisms underpinning biologically aggressive disease and offer opportunities for therapeutic intervention. Endometrial cancer is the commonest gynaecological malignancy in developed countries, and women presenting with high risk or advanced disease have poor outcomes. Thyroid hormones play a key role in cellular metabolism and can influence cancer growth and invasion. Our aim was to evaluate the association between clinical and biochemical thyroid dysfunction and endometrial cancer survival outcomes. This was a prospective cohort study of women treated for endometrial cancer at a specialist centre. Clinical diagnosis of hypothyroidism was based on clinical and biochemical assessment, verified by general practitioner (GP) records. Pre-treatment serum samples were tested for thyrotropin (TSH), thyroid hormones (free T4 and total T3), and thyroid peroxidase antibodies. Kaplan–Meier survival estimates and log-rank tests were used to compare survival between groups, while Cox regression was used for multivariable analysis, adjusting for known confounders and effect modifications. In total, 333 women with median age and body mass index (BMI) of 66 years (interquartile range (IQR) 56, 73) and 33 kg/m2 (IQR 27, 41) respectively were included. A total of 51 (15.3%) women had a diagnosis of hypothyroidism, 39 (11.9%) had biochemical evidence of overt or subclinical hypothyroidism. Median follow-up was 35 months (IQR 21, 45) with 38 (11.7%) relapses and 50 (15.0%) deaths. Women with a diagnosis of hypothyroidism had improved overall survival (adjusted HR = 0.22, 95%CI 0.06–0.74, p = 0.02), cancer-specific survival (adjusted HR = 0.21, 95%CI 0.05–0.98, p = 0.04) and fewer recurrences (adjusted HR = 0.17, 95%CI 0.04–0.77, p = 0.02) than those who did not. Confirmatory studies should explore underlying mechanisms and the potential for therapeutic exploitation.
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影响因子：
6.2
作者：
Cristofanilli, M;Yamamura, Y;Hortobagyi, GN
通讯作者：
Hortobagyi, GN
影响因子：
8
作者：
Dinda, S;Sanchez, A;Moudgil, V
通讯作者：
Moudgil, V
DOI：
10.1016/s0140-6736(17)30703-1
发表时间：
2017-09-23
期刊：
Lancet (London, England)
影响因子：
--
作者：
Chaker L;Bianco AC;Jonklaas J;Peeters RP
通讯作者：
Peeters RP
DOI：
10.1530/joe-17-0708
发表时间：
2018-04
期刊：
The Journal of endocrinology
影响因子：
--
作者：
Anyetei-Anum CS;Roggero VR;Allison LA
通讯作者：
Allison LA
影响因子：
4.7
作者：
Kitson SJ;Lindsay J;Sivalingam VN;Lunt M;Ryan NAJ;Edmondson RJ;Rutter MK;Crosbie EJ
通讯作者：
Crosbie EJ