[Clinical and pathological differences between papillary thyroid carcinoma with Graves' disease and papillary thyroid carcinoma with Hashimoto's thyroiditis].

Objective: To explore the clinical and pathological differences between papillary thyroid carcinoma (PTC) with Graves' disease (GD) and PTC with Hashimoto's thyroiditis (HT). Methods: A total of 33 PTC patients with GD and 132 PTC patients with HT in the First Affiliated Hospital of China Medical University from January 2009 to December 2015 were enrolled. The clinical and histopathological data were analyzed. Results: The average serum concentration of thyroid stimulating hormone (TSH) of PTCs with GD was significantly lower than PTCs with HT [0.01 (0, 0.10) mU/L vs 2.28(1.51, 3.14) mU/L, P<0.001]. However, there was no significant difference between the two groups in nodule diameter [(15.7±7.0) mm vs (13.5±7.8)mm, P=0.14], percentage of lymph node metastasis (LNM) [33.3%(11/33) vs 39.4%(52/132), P=0.52], TNM stage Ⅲ-Ⅳ disease [12.1%(4/33) vs 11.4% (15/132), P=1.00], papillary thyroid micro-carcinoma (PTMC) [60.6% (20/33) vs 60.6%(80/132), P=1.00]and classic PTC in all its variant patterns [81.8%(27/33) vs 75.0%(99/132), P=0.36]. The age (P<0.01, OR=0.95, 95%CI: 0.92-0.98) and PTMC (P<0.01, OR=0.30, 95%CI: 0.13-0.67), rather than TSH (P=0.08) were independently correlated with LNM. Recurrence rate of PTC with GD was significantly lower than PTC with HT (log-rank test, P=0.03). In Cox proportional hazards regression model, variant pattern of PTC was independently correlated with recurrence rate (P<0.05). Conclusions: GD with PTC wasn't different from HT concomitant with PTC, except for thyroid function test. In addition, recurrence rate of PTC with GD was lower than that of PTC with HT after controlling TSH in the same level.目的： 探讨Graves病(GD)合并甲状腺乳头状癌(PTC)与桥本甲状腺炎(HT)合并PTC临床及病理特征的差异。 方法： 回顾性分析中国医科大学附属第一医院2009年1月至2015年12月诊断为GD合并PTC的33例患者资料，并随机抽取HT合并PTC的132例患者作为对照。对比分析两组患者的甲状腺功能、结节直径、淋巴结转移(LNM)、TNM分期、甲状腺微小乳头状癌(PTMC)及PTC病理亚型的差异，采用Kaplan－Meier法比较两组复发率的差异、Cox回归模型探索影响PTC患者术后复发的因素。 结果： 与HT合并PTC组相比，GD合并PTC组患者的血清促甲状腺激素(TSH)浓度较低[0.01(0，0.10) mU/L比2.28(1.51，3.14) mU/L，P<0.01]。两组患者结节直径差异无统计学意义[(15.7±7.0)mm比(13.5±7.8)mm，P＝0.14]。LNM[33.3%(11/33)比39.4%(52/132)，P＝0.52]、TNM Ⅲ～Ⅳ期[12.1%(4/33)比11.4%(15/132)，P＝1.00]、PTMC[60.6%(20/33)比60.6%(80/132)，P＝1.00]及普通型PTC[81.8%(27/33)比75.0%(99/132)，P＝0.36]所占比例两组间差异均无统计学意义。单因素及多因素logistic回归结果显示，高龄(P<0.01，OR＝0.95，95%CI：0.92～0.98)和PTMC(P<0.01，OR＝0.30，95%CI：0.13～0.67)，而非TSH(P＝0.08)，是LNM的独立相关因素。Kaplan－Meier生存分析结果显示，经统一规范的TSH抑制治疗后，GD合并PTC组的复发率显著低于HT合并PTC组(log－rank检验，P＝0.03)。Cox回归模型提示PTC病理亚型与复发率独立相关(P<0.05)。 结论： GD合并PTC与HT合并PTC在临床、病理特征方面，除甲状腺功能外，无明显差异。经统一规范的TSH抑制治疗后，GD合并PTC的复发率低于HT合并PTC的复发率。.