甲状腺微小乳头状癌伴和不伴桥本甲状腺炎的临床病理学特征比较  

Comparison of Clinicopathological Features Between Papillary Thyroid Microcarcinoma Patients with and Without Hashimoto Thyroiditis

作　　者：钱昌林[1] 柳怿[2] 沈志勇[1] 刘骅[1] 季福[1] 

机构地区：[1]上海交通大学医学院附属仁济医院(南院)普外科,上海201112 [2]上海交通大学医学院附属仁济医院(南院)超声医学科,上海201112

出　　处：《中国普外基础与临床杂志》2016年第6期742-746,共5页Chinese Journal of Bases and Clinics In General Surgery

摘　　要：目的探讨甲状腺微小乳头状癌(PTMC)伴和不伴桥本甲状腺炎(HT)患者临床病理学特征的差异,同时比较两者BRAF^(V600E)的表达情况。方法回顾性收集2012年12月至2015年6月期间于上海交通大学医学院附属仁济医院(南院)行手术治疗的168例PTMC患者的临床资料,其中伴发HT患者49例(伴发HT组),不伴HT患者119例(不伴HT组)。比较2组患者的临床病理学特征及其BRAF^(V600E)表达的差异。结果伴发HT组和不伴HT组患者的性别构成、年龄和肿瘤直径比较差异均有统计学意义(P<0.050),伴发HT组患者中女性、年龄<45岁及肿瘤直径≤0.5 cm患者的比例较高。伴发HT组患者中BRAF^(V600E)表达阳性32例(65.31%,32/49),不伴HT组患者中BRAF^(V600E)表达阳性84例(70.59%,84/119),两者的BRAF^(V600E)表达阳性率比较差异无统计学意义(P>0.050)。在伴发HT的患者中,BRAF^(V600E)表达程度与性别、被膜侵犯情况及淋巴结转移情况均相关,女性、无被膜侵犯及无淋巴结转移者的BRAF^(V600E)表达程度较弱(P<0.050)。在被膜外侵犯和淋巴结转移患者中,伴发HT患者的BRAF^(V600E)表达较不伴HT患者弱(P<0.050)。结论伴发HT的PTMC患者女性较多、年龄较小,肿瘤直径较小,可能是其预后较好的原因。此外,BRAF^(V600E)表达较弱可能是伴发HT、存在淋巴结转移和被膜侵犯的PTMC患者预后较好的原因。Objective To compare the clinicopathological features and expression of BRAF^V600E between papillary thyroid microcarcinoma（PTMC） patients with and without Hashimoto thyroiditis（HT）. Methods Clinical data of 168 PTMC patients who underwent surgery in South Campus of Renji Hospital from Dec. 2012 to Jun. 2015 were collected. Of the 168 PTMC patients, 49 patients combined with HT（HT group） and 119 patients without HT（non-HT group）. Comparison of clinicopathological features and expression of BRAF^V600E between the 2 groups was performed. Results There was significant difference in the gender, age, and diameter of tumor between the 2 groups（P〈0.050）, the ratios of patients with 45 years old, female, diameter of tumor ≤0.5 cm of HT group were higher. But there was no significant difference in the expression rate of BRAF^V600E between the HT group 〔65.31%（32/49）〕 and non-HT group 〔70.59%（84/119）〕, P〈0.050. In patients combined with HT, expression of BRAF^V600E was weaker in female patients, patients without capsule invasion and lymph node metastasis（P〈0.050）. In patients with capsule invasion and lymph node metastasis, expression of BRAF^V600E was weaker in patients of HT group than those of non-HT group（P〈0.050）. Conclusions The prognosis was better in PTMC patients who combined with HT, that may because of higher ratio of female and younger patients, and smaller diameter of tumor. Weakly expression of BRAF^V600E may be the reason of better prognosis in HT patients with capsule invasion and lymph node metastasis.

关 键 词：甲状腺微小乳头状癌 桥本甲状腺炎 BRAF^V600E 

分 类 号：R736.1[医药卫生—肿瘤] R581.4[医药卫生—临床医学]