.: ORİJİNAL ARAŞTIRMA
Kronik Lenfositik Tiroidit ve Papiller Tiroid Karsinomu Birlikteliğinde Klinik Sonuçları Etkileyen Faktörler
Factors Influencing Clinical Outcomes in Coexistence of Chronic Lymphocytic Thyroiditis with Papillary Thyroid Carcinoma
Turkiye Klinikleri J Intern Med. 2020;5(1):8-14
doi: 10.5336/intermed.2019-70935
Makale Dili: TR
Tam Metin
Ücretsiz Erişim
ÖZET
Amaç: Kronik lenfositik tiroidit (KLT) zemininde gelişen papiller tiroid karsinom (PTK) hastalarında, birçok parametre üzerinden KLT varlığının, prognoz üzerine olumlu etkileri olduğu ileri sürülmektedir. Ancak literatürde aksi görüşler de mevcuttur. Çalışmamızda, KLT ve PTK birlikteliğinin klinik prognoz üzerine etkisini araştırdık. Gereç ve Yöntemler: Ocak 2014-Ağustos 2018 tarihleri arasında tiroidektomi geçirmiş 259 (232 K, 27 E) hasta, PTK tanısı (144 papiller mikrokarsinom) almıştı. 170 (%65) hastada PTK yanında histopatolojik olarak KLT tanısı mevcuttu. Yaş, cinsiyet, nodül çapı (<2 cm), nodül sayısı (>2), preoperatif ince iğne aspirasyon biyopsi (İİAB) sonucu, operasyon tipi, tümör alt grubu, tümör çapı, multifokalite, lenf nodu metastazı (LNM), kapsül invazyonu, ekstratiroidal yayılım (ETY), risk grubu ve rekürrens parametreleri KLT varlığının etkilerini araştırmada kullanıldı. Grupların istatiksel karşılaştırılmasında SPSS programı 18.0 versiyonu kullanıldı. p<0,05 değeri anlamlı kabul edildi. Bulgular: Nodül çapı 2 cm'den küçük olan hastalarda KLT varlığı daha sık gözlendi (p=0,004). KLT varlığı olan hastalarda ETY anlamlı olarak daha az saptandı (p=0,017). KLT varlığı olan hastaların çoğunluğu düşük risk grubunda idi (p=0,05). Sonuç: Eşlik eden KLT varlığında papiller mikrokarsinom daha sık gözlenmektedir. Çalışmamızda, KLT zemininde gelişen PTK olgularının, 2 cm'den küçük çaplı nodüllerde ve daha erken evrede saptandığı, daha az sıklıkta ETY gösterdiği sonucuna varılmıştır.
Anahtar Kelimeler: Tiroid kanseri; kronik lenfositik tiroidit
Amaç: Kronik lenfositik tiroidit (KLT) zemininde gelişen papiller tiroid karsinom (PTK) hastalarında, birçok parametre üzerinden KLT varlığının, prognoz üzerine olumlu etkileri olduğu ileri sürülmektedir. Ancak literatürde aksi görüşler de mevcuttur. Çalışmamızda, KLT ve PTK birlikteliğinin klinik prognoz üzerine etkisini araştırdık. Gereç ve Yöntemler: Ocak 2014-Ağustos 2018 tarihleri arasında tiroidektomi geçirmiş 259 (232 K, 27 E) hasta, PTK tanısı (144 papiller mikrokarsinom) almıştı. 170 (%65) hastada PTK yanında histopatolojik olarak KLT tanısı mevcuttu. Yaş, cinsiyet, nodül çapı (<2 cm), nodül sayısı (>2), preoperatif ince iğne aspirasyon biyopsi (İİAB) sonucu, operasyon tipi, tümör alt grubu, tümör çapı, multifokalite, lenf nodu metastazı (LNM), kapsül invazyonu, ekstratiroidal yayılım (ETY), risk grubu ve rekürrens parametreleri KLT varlığının etkilerini araştırmada kullanıldı. Grupların istatiksel karşılaştırılmasında SPSS programı 18.0 versiyonu kullanıldı. p<0,05 değeri anlamlı kabul edildi. Bulgular: Nodül çapı 2 cm'den küçük olan hastalarda KLT varlığı daha sık gözlendi (p=0,004). KLT varlığı olan hastalarda ETY anlamlı olarak daha az saptandı (p=0,017). KLT varlığı olan hastaların çoğunluğu düşük risk grubunda idi (p=0,05). Sonuç: Eşlik eden KLT varlığında papiller mikrokarsinom daha sık gözlenmektedir. Çalışmamızda, KLT zemininde gelişen PTK olgularının, 2 cm'den küçük çaplı nodüllerde ve daha erken evrede saptandığı, daha az sıklıkta ETY gösterdiği sonucuna varılmıştır.
Anahtar Kelimeler: Tiroid kanseri; kronik lenfositik tiroidit
ABSTRACT
Objective: The presence of chronic lymphocytic thyroiditis (CLT) in patients with papillary thyroid carcinoma (PTC) has been suggested to have positive effects on prognosis. However, there are contradictory views in the literature. In our study, we investigated the effect on clinical prognosis of the coexistence of CLT with PTC. Material and Methods: 259 (232F, 27M) patients who underwent thyroidectomy between January 2014 and August 2018 were diagnosed with PTC (144 papillary microcarcinoma). In 170 (65%) patients, PTC was diagnosed with CLT histopathologically. Age, gender, nodule diameter (< 2 cm), number of nodules (> 2), preoperative fine needle aspiration biopsy (FNAB) result, type of operation, tumor subgroup, tumor diameter, multifocality, lymph node metastasis (LNM), capsule invasion, extrathyroidal extension (ETE), risk group, and recurrence parameters were used to investigate the effects of CLT. SPSS programme 18.0 version was used for statistical analysis of the groups. p<0.05 values were considered as significant. Results: The presence of CLT was more frequent in patients with nodule diameter smaller than 2 cm (p=0.004). ETE was significantly lower in patients with CLT (p=0.017). The majority of patients with CLT were in the low-risk group (p=0.05). Conclusion: Papillary microcarcinoma is more common in the presence of concomitant CLT. In our study, it was concluded that patients with PTC developing on the background of CLT were detected in nodules diameter smaller than 2 cm and in earlier stage and ETE was less frequently.
Keywords: Thyroid cancer; chronic lymphocytic thyroiditis
Objective: The presence of chronic lymphocytic thyroiditis (CLT) in patients with papillary thyroid carcinoma (PTC) has been suggested to have positive effects on prognosis. However, there are contradictory views in the literature. In our study, we investigated the effect on clinical prognosis of the coexistence of CLT with PTC. Material and Methods: 259 (232F, 27M) patients who underwent thyroidectomy between January 2014 and August 2018 were diagnosed with PTC (144 papillary microcarcinoma). In 170 (65%) patients, PTC was diagnosed with CLT histopathologically. Age, gender, nodule diameter (< 2 cm), number of nodules (> 2), preoperative fine needle aspiration biopsy (FNAB) result, type of operation, tumor subgroup, tumor diameter, multifocality, lymph node metastasis (LNM), capsule invasion, extrathyroidal extension (ETE), risk group, and recurrence parameters were used to investigate the effects of CLT. SPSS programme 18.0 version was used for statistical analysis of the groups. p<0.05 values were considered as significant. Results: The presence of CLT was more frequent in patients with nodule diameter smaller than 2 cm (p=0.004). ETE was significantly lower in patients with CLT (p=0.017). The majority of patients with CLT were in the low-risk group (p=0.05). Conclusion: Papillary microcarcinoma is more common in the presence of concomitant CLT. In our study, it was concluded that patients with PTC developing on the background of CLT were detected in nodules diameter smaller than 2 cm and in earlier stage and ETE was less frequently.
Keywords: Thyroid cancer; chronic lymphocytic thyroiditis
REFERANSLAR:
- Hodgson NC, Button J, Solorzano CC. Thyroid cancer: is the incidence stil increasing? Ann Surg Oncol. 2004;11(12):1093-7. [Crossref] [PubMed]
- Udelsman R, Chen H. The current management of thyroid cancer. Adv Surg. 1999;33:1-27.
- Liang J, Zeng W, Fang F, Yu T, Zhao Y, Fan X, et al. Clinical analysis of Hashimoto thyroiditis coexistent with papillary thyroid cancer in 1392 patients. Acta Otorhinolaryngol Ital. 2017;37(5):393-400.
- Zhang Y, Ma XP, Deng FS, Liu ZR, Wei HQ, Wang XH, et al. The effect of chronic lymphocytic thyroiditis on patients with thyroid cancer. World J Surg Oncol. 2014;12:277. [Crossref] [PubMed] [PMC]
- Baser H, Ozdemir D, Cuhaci N, Aydin C, Ersoy R, Kilicarslan A, et al. Hashimoto's thyroiditis does not affect ultrasonographical, cytological, and histopathological features in patients with papillary thyroid carcinoma. Endocr Pathol. 2015;26(4):356-64. [Crossref] [PubMed]
- Vita R, Ieni A, Tuccari G, Benvenga S. The increasing prevalence of chronic lymphocytic thyroiditis in papillary microcarcinoma. Rev Endocr Metab Disord. 2018;19(4):301-9. [Crossref] [PubMed]
- Kebebew E, Treseler PA, Ituarte PH, Clark OH. Coexisting chronic lymphocytic thyroiditis and papillary thyroid cancer revisited. World J Surg. 2001;25(5):632-7. [Crossref] [PubMed]
- Dailey ME, Lindsay S, Skahen R. Relation of thyroid neoplasms to Hashimoto disease of the thyroid gland. AMA Arch Surg. 1955;70(2):291-7. [Crossref] [PubMed]
- Okayasu I, Fujiwara M, Hara Y, Tanaka Y, Rose NR. Association of chronic lymphocytic thyroiditis and thyroid papillary carcinoma. A study of surgical cases among Japanese, and white and African Americans. Cancer. 1995;76(11):2312-8. [Crossref]
- Kim EY, Kim WG, Kim WB, Kim TY, Kim JM, Ryu JS, et al. Coexistence of chronic lymphocytic thyroiditis is associated with lower recurrence rates in patients with papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2009;71(4):581-6. [Crossref] [PubMed]
- Loh KC, Greenspan FS, Dong F, Miller TR, Yeo PP. Influence of lymphocytic thyroiditis on the prognostic outcome of patients with papillary thyroid carcinoma. J Clin Endocrinol Metab. 1999;84(2):458-63. [Crossref] [PubMed]
- Ersoy R, Gül K, Korukluoğlu B, Ersoy PE, Aydın R, Aydın C, et al. [Coexistent thyroid papillary carcinoma with chronic lymphocytic thyroiditis]. Turk Med J. 2007;1(3):119-122.
- Uhliarova B, Hajtman A. [Hashimoto's thyroiditis-an independent risk factor for papillary carcinoma]. Braz J Otorhinolaryngol. 2018;84(6):729-35. [Crossref] [PubMed]
- Jeong JS, Kim HK, Lee CR, Park S, Park JH, Kang SW, et al. Coexistence of chronic lymphocytic thyroiditis with papillary thyroid carcinoma: clinical manifestation and prognostic outcome. J Korean Med Sci. 2012;27(8):883-9. [Crossref] [PubMed] [PMC]
- Paulson LM, Shindo ML, Schuff KG. Role of chronic lymphocytic thyroiditis in central node metastasis of papillary thyroid carcinoma. Otolaryngol Head Neck Surg. 2012;147(3):444-9. [Crossref] [PubMed]
- Song E, Jeon MJ, Park S, Kim M, Oh HS, Song DE, et al. Influence of coexistent Hashimoto's thyroiditis on the extent of cervical lymph node dissection and prognosis in papillary thyroid carcinoma. Clin Endocrinol (Oxf). 2018;88(1):123-8. [Crossref] [PubMed]
- Babli S, Payne RJ, Mitmaker E, Rivera J. Effects of chronic lymphocytic thyroiditis on the clinicopathological features of papillary thyroid cancer. Eur Thyroid J. 2018;7(2):95-101. [Crossref] [PubMed] [PMC]
- Kim HS, Choi YJ, Yun JS. Features of papillary thyroid microcarcinoma in the presence and absence of lymphocytic thyroiditis. Endocr Pathol. 2010;21(3):149-53. [Crossref] [PubMed]
- Jara SM, Carson KA, Pai SI, Agrawal N, Richmon JD, Prescott JD, et al. The relationship between chronic lymphocytic thyroiditis and central neck lymph node metastasis in North American patients with papillary thyroid carcinoma. Surgery. 2013;154(6):1272-80. [Crossref] [PubMed]
- Del Rio P, Cataldo S, Sommaruga L, Concione L, Arcuri MF, Sianesi M. The association between papillary carcinoma and chronic lymphocytic thyroiditis: does it modify the prognosis of cancer? Minerva Endocrinol. 2008;33(1):1-5. [Crossref] [PubMed]
- Hashimoto H. Zur kenntniss der lymphomatosen verändderung der schilddrüse (struma lymphomatosa). Arch Klin Chirurg. 1912;97:219-48.
- Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357(9255):539-45. [Crossref]
- McLeod DS, Watters KF, Carpenter AD, Ladenson PW, Cooper DS, Ding EL. Thyrotropin and thyroid cancer diagnosis: a systematic review and dose-response meta-analysis. J Clin Endocrinol Metab. 2012;97(8):2682-92. [Crossref] [PubMed]
- Boelaert K, Horacek J, Holder RL, Watkinson JC, Sheppard MC, Franklyn JA. Serum thyrotropin concentration as a novel predictor of malignancy in thyroid nodules investigated by fine-needle aspiration. J Clin Endocrinol Metab. 2006;91(11):4295-301. [Crossref] [PubMed]
- Anand A, Singh KR, Kushwaha JK, Hussain N, Sonkar AA. Papillary thyroid cancer and Hashimoto's thyroiditis: an association less understood. Indian J Surg Oncol. 2014;5(3):199-204. [Crossref] [PubMed] [PMC]
- Jonklaas J, Nsouli-Maktabi H, Soldin SJ. Endogenous thyrotropin and triiodothyronine concentrations in individuals with thyroid cancer. Thyroid. 2008;18(9):943-52. [Crossref] [PubMed] [PMC]
- Haymart MR, Repplinger DJ, Leverson GE, Elson DF, Sippel RS, Jaume JC, et al. Higher serum thyroid stimulating hormone level in thyroid nodule patients is associated with greater risks of differentiated thyroid cancer and advanced tumor stage. J Clin Endocrinol Metab. 2008;93(3):809-14. [Crossref] [PubMed] [PMC]
- Polyzos SA, Kita M, Efstathiadou Z, Poulakos P, Slavakis A, Sofianou D, et al. Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules. J Cancer Res Clin Oncol. 2008;134(9):953-60. [Crossref] [PubMed]
- Resende de Paiva C, Grønhøj C, Feldt-Rasmussen U, von Buchwald C. Association between Hashimoto's thyroiditis and thyroid cancer in 64,628 patients. Front Oncol. 2017;7:53. [Crossref] [PubMed] [PMC]
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