甲状腺癌并存桥本甲状腺炎的临床和病理分析

  目的  探讨甲状腺癌与桥本甲状腺炎(Hashimoto'sthyroiditis, HT)并存的临床和病理特点。  方法  对2006年1月至2010年12月本院手术治疗、病理证实的甲状腺癌并存HT的218例患者的临床和病理特点进行回顾性分析。  结果  甲状腺癌与HT并存占同期所有甲状腺癌手术病例的12.6%(218/1731), 占同期手术治疗、病理证实HT病例的41.1%(218/531), 病理组织学类型以乳头状癌为主占95.4%(208/218)。甲状腺癌合并HT组较未合并HT组更好发于女性(94.1%vs.77.7%, P=0.000 1), 超声诊断率低(51.8%vs.75.1%, P=0.0001), 冰冻诊断率低(78.4%vs.94.8%, P=0.000 1), 微小癌发病率更高(43.0%vs.32.9%, P=0.043), 淋巴结转移率更低(55.0%vs.63.3%, P=0.048), AJCC/UICC分期更早(Ⅰ期80.7%vs.67.1%, Ⅳ期4.1%vs.8.4%, P=0.0001)。  结论  甲状腺癌与HT关系密切, 二者并存具有好发于女性、术前诊断困难、预后较好等临床特点, 甲状腺全切除或者近全切除+Ⅰ期中央区颈淋巴结清扫应作为其基本术式。 

Clinical and Pathological Analysis of Thyroid Carcinoma Coexistent with Hashimoto's Thyroiditis

  Objective   To investigate the clinical and pathological features of thyroid carcinoma(TC) coexistent with Hashimoto's thyroiditis(HT).   Methods   A retrospective study was conducted on the clinical and pathological features of 218 patients with TC coexistent with HT.These patients were treated in The First Affiliated Hospital of Fujian Medical University between January 2006 and December 2010.   Results   The TC with coexistence of HT cases accounted for 12.6%(218/1 731) of all the TC cases and 41%(218 / 531) in all the HT cases.Papillary thyroid cancer ranked first in the histological classification, accounting for 95.5%(208 / 218).The case of TC with coexistence of HT was more commonly observed in the female patients compared with TC without the coexistence of HT(94.1%vs.77.7%, P=0.000 1).The rate of ultrasonic diagnosis was very low in the cases(51.8%vs.75.1%, P=0.000 1), and the rate of pathological diagnosis by frozen diagnosis was also low(78.4%vs.94.8%, P=0.000 1), with a higher incidence of minimum cancer(43%vs.32.9%, P=0.043), a lower rate of nodal metastasis(55.0%vs.63.3%, P=0.048), and earlier AJCC / UICC staging(stageⅠ: 80.7%vs.67.1%;stageⅣ: 4.1%vs.8.4%, P=0.000 1).   Conclusion   A close relationship exists between TC and HT.TC complication with HT would have several clinical features, such as a tendency of occurrence in females, more difficult preoperative diagnosis, and a more favorable prognosis.Total or near total thyroidectomy combined with central cervical lymph node dissection should be used as the basic mode of surgery for TC coexistent with HT.