摘要
目的:探讨并分析合并淋巴细胞性甲状腺炎(lymphocytic thyroiditis,LT)的甲状腺乳头状癌(papillary thyroid carcinoma,PTC)的临床病理特征及生物学特征(BRAFV600E突变、RET蛋白表达)。方法:收集262例PTC患者,根据是否合并LT分为A(合并LT,n=77)、B(不合并LT,n=185)两组。分别统计两组年龄、性别、肿瘤大小、多灶性、包膜外侵、淋巴结转移和远处转移等临床病理特征。采用RT-PCR法检测PTC组织中BRAFV600E突变,免疫组化法检测RET在PTC组织中表达。结果:PTC合并LT比例为29.39%(77/262)。A组女性比例(84.42%)高于B组(61.08%),P<0.001。A组和B组肿瘤大小分别为(1.32±0.74)和(1.72±1.28)cm,P=0.002;甲状腺包膜外侵犯率分别为28.57%和72.97%,P<0.001;远处转移率分别为6.49%和16.76%,P=0.028;BRAFV600E突变阳性率分别为39.71%和78.52%,P<0.001。A组均显著低于B组,差异均有统计学意义,P<0.05。A组和B组RET蛋白表达阳性率分别为76.47%和53.33%,差异有统计学意义,P=0.001。A组和B组在多灶性、淋巴结转移及TNM分期方面则差异无统计学意义。在相同TSH水平下,A组和B组患者术前Tg水平分别为(11.52±26.46)和(48.92±167.12)ng/mL,P=0.261;Anti-Tg水平分别为(324.06±469.50)和(64.89±160.07)IU/mL,P=0.005;Anti-TPO水平分别为(219.36±273.03)和(23.33±43.62)IU/mL,P=0.001。术后131I治疗前Tg水平分别为(15.56±82.39)和(78.55±196.22)ng/mL,P=0.001。Anti-Tg水平分别为(226.44±315.62)和(94.07±389.71)IU/mL,P=0.019;Anti-TPO水平分别为(88.46±120.89)和(16.54±24.79)IU/mL,P=0.013。结论:RET蛋白表达与PTC合并LT的发生密切相关,BRAFV600E突变在PTC合并LT患者中较少见。淋巴细胞性甲状腺炎可作为一种保护机制降低PTC患者局部及远处侵袭性。
OBJECTIVE：To explore and analyze the clinicopathological and biological features of papillary thyroid carcinoma concurrent with lymphocytic thyroiditis. METHODS：Totally 262 cases of PTC patients were divided into group A （PTC with LT, n = 77） and group B （PTC without LT, n = 185 ）. Ages, gender, tumor sizes, extrathyroidal invasion, muhifocality,lymph node metastasis,distant metastasis and TNM stages were collected for analysis. BRAF^V600E mutation and RET expression was detected by RT-PCR and IHC （immunohistochemistry）. RESULTS： LT was confirmed in 29.39% of all PTC patients. The cohort with LT revealed a higher frequency of female patients （84.42% vs 61.08% ,P〈 0. 001） and positive RET expression （76. 47% vs 53. 33%, P = 0. 001）, smaller tumor size （1. 32 ±0. 74） cm vs （ 1.72 ± 1.28） cm （P = 0.002）, a lower frequency of extrathyroidal invasion （28.57 % vs 72.97 %, P〈 0.001 ）, distant metastasis （6.49% vs 16.67% ,P=0. 028） and BRAF^v600E mutation （39.71% vs 78.52% ,P〈0. 001）. There was no significant difference between the two group in muhifocality,lymph node metastasis and TNM stages. The Tgs before surgery of Group A and B were （11.52±26.46） and （48.92±167.12） ng/mL （P=0. 261） ;Anti-Tgs were （324.06±469.50） and （64.89±160.07） IU/mL （P=0. 005）;Anti-TPos were （219.36±273.03） and （23.33±43.62） IU/mL （P=0. 001）. The Tgs after surgery （before RAI treatment） of Group A and B were （15.56±82.39） and （78.55±196.22） ng/mL （P=0. 001） ;Anti-Tg are （226. 44±315. 62） and （94. 07 ± 389.71） IU/mL （P= 0. 019） ; Anti-TPos were （88. 46 ±120.89） and （16.54±24.79） IU/mL （P=0. 013）. CONCLUSIONS：RET expression is related to coexistent LT in PTC. BRAF^V600E mutation is less frequent in PTC with HT than those without HT. Lymphocytic thyroiditis represents a protective form of host immune response to reduce the aggressiveness of PTC. [
出处
《中华肿瘤防治杂志》
CAS
北大核心
2013年第17期1331-1335,共5页
Chinese Journal of Cancer Prevention and Treatment
基金
国家自然科学基金(30970850)
