甲状腺乳头状癌合并乳腺癌患者的临床病理特征分析

目的: 分析甲状腺乳头状癌(papillary thyroid carcinoma,PTC)合并乳腺癌患者的临床病理特征，探讨两癌之间可能存在的联系。方法: 选择2016年12月至2021年12月郑州大学第一附属医院甲状腺外科收治的99例PTC合并乳腺癌患者(合并癌组)，另选择同期收治的99例未发现乳房结节的PTC患者(单纯癌组)，比较两组患者一般特征、PTC病理特征、甲状腺激素及抗原抗体水平。根据确诊顺序及间隔时间将PTC合并乳腺癌患者分为乳甲组(乳腺癌后确诊PTC)、甲乳组(PTC后确诊乳腺癌)、同时组(两癌确诊间隔时间不超过6个月)，比较3组患者确诊PTC及乳腺癌年龄、两癌确诊间隔时间、PTC淋巴结转移情况及乳腺癌病理特征。结果: 与单纯癌组相比，合并癌组肿瘤最大径更小，更倾向于微小癌，不易侵犯被膜及周围组织，确诊PTC时年龄明显增高，多处于绝经状态，且血清游离四碘甲状腺原氨酸(serum free tetraiodothyronine,FT4)水平明显降低，甲状腺球蛋白(thyroglobulin,Tg)、甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)和促甲状腺素受体抗体(thyrotropin receptor antibody,TRAb)表达水平明显升高(P均<0.05)。与甲乳组相比，乳甲组两癌确诊间隔时间明显缩短(P<0.05)；与同时组相比，乳甲组颈侧区淋巴结转移率明显增高(P<0.05)。结论: PTC合并乳腺癌患者甲状腺肿瘤最大径更小，部分患者发展迅速且易出现跳跃性转移；Tg、TPOAb和TRAb高表达的PTC患者乳腺癌发病风险增高。

Clinicopathological characteristics of patients with papillary thyroid carcinoma combined with breast cancer

Objective To analyse the clinicopathological features of patients with papillary thyroid carcinoma (PTC) combined with breast cancer and to explore the possible relationship between these two cancers. Methods A total of 99 patients with PTC combined with breast cancer (combined cancer group) who were admitted to the Thyroid Surgery Department of the First Affiliated Hospital of Zhengzhou University from December 2016 to December 2021 were selected, and 99 patients with PTC without breast nodule (simple cancer group) who were treated during the same period were selected. The general characteristics, PTC pathological characteristics, thyroid hormone, antigen and antibody levels were compared between the two groups. According to the order of diagnosis and the interval time, the patients with PTC combined with breast cancer were divided into breast-thyroid group (diagnosed with PTC after breast cancer), thyroid-breast group (diagnosed with breast cancer after PTC) and simultaneous group (the interval between the diagnosis of two cancers did not exceed 6 months). The age at diagnosis of PTC and breast cancer, the interval between diagnosis of two cancers, the lymph node metastasis of PTC and pathological characteristics of breast cancer were compared among the three groups. Results Compared with the simple cancer group, the tumor in the combined cancer group was smaller in maximum diameter, more inclined to microcarcinoma, and less likely to invade the capsule and surrounding tissues; the age at the time of diagnosis of PTC was significantly older, most of them were in menopausal state; the level of serum free tetraiodothyronine (FT4) was also significantly decreased, while the level of thyroglobulin (Tg), thyroid peroxidase antibody (TPOAb) and thyrotropin receptor antibody (TRAb) were significantly increased (all P<0.05). Compared with the thyroid-breast group, the interval between diagnosis of two cancers in the breast-thyroid group was significantly shorter (P<0.05). Compared with the simultaneous group, the rate of cervical lymph node metastasis in the breast-thyroid group was significantly higher (P<0.05). Conclusion Thyroid tumors in patients with PTC combined with breast cancer were smaller in maximum diameter, and some patients developed rapidly and were prone to skip metastasis; PTC patients with high expression level of Tg, TPOAb and TRAb had an increased risk of breast cancer. ［Key words］papillary thyroid carcinoma; breast cancer; thyroid hormone; thyroglobulin; thyroid associated antibody; lymph node metastasis; microcarcinoma