Advances in Clinical Medicine
Vol. 11  No. 12 ( 2021 ), Article ID: 47304 , 6 pages
10.12677/ACM.2021.1112856

女性甲状腺乳头状癌患者共患乳腺癌的临床病理特征分析

寻增欣1,孙梦媛1,2,张静文1,李文凤3,王斐1*

1青岛大学附属医院内分泌科,山东 青岛

2淄博市沂源县人民医院,山东 淄博

3青岛大学附属医院乳腺病诊疗中心,山东 青岛

收稿日期:2021年11月16日;录用日期:2021年12月6日;发布日期:2021年12月20日

摘要

目的:通过对共患甲状腺乳头状癌(PTC)和乳腺癌女性患者的甲状腺乳头状癌临床病理特征进行分析,探究女性甲状腺乳头状癌患者共患乳腺癌的相关因素。方法:选取PTC的女性患者428例,其中单纯PTC患者327例,PTC合并乳腺癌患者101例,收集PTC的临床病理资料,分析比较两组间的临床及病理特征。结果:甲状腺乳头状癌共患乳腺癌组的年龄、肿瘤大小、包膜浸润率、颈部淋巴结转移率有统计学意义(均P < 0.05)。多因素Logistic回归分析显示,PTC患者共患乳腺癌的风险与年龄(OR = 1.056,95% CI为1.030~1.082)呈正相关,与肿瘤大小(OR = 0.466,95% CI为0.275~0.725)、颈部淋巴结转移率(OR = 0.562,95% CI为0.324~0.975)呈负相关。结论:年龄增大可增加PTC共患乳腺癌的风险;共患乳腺癌的PTC患者相较于单纯PTC患者而言,PTC的肿瘤小,淋巴结转移率较低。

关键词

甲状腺乳头状癌,乳腺癌,多原发癌,临床病理特征,相关因素

Analysis of Clinicopathological Characteristics of Papillary Thyroid Cancer with Breast Cancer in Female Patients

Zengxin Xun1, Mengyuan Sun2, Jingwen Zhang1, Wenfeng Li3, Fei Wang1*

1Department of Endocrinology, The Affiliated Hospital of Qingdao University, Qingdao Shandong

2Yiyuan County People’s Hospital, Zibo Shandong

3Breast Center, The Affiliated Hospital of Qingdao University, Qingdao Shandong

Received: Nov. 16th, 2021; accepted: Dec. 6th, 2021; published: Dec. 20th, 2021

ABSTRACT

Objective: We analyzed the clinicopathological characteristics of papillary thyroid cancer (PTC) in female papillary thyroid cancer patients with breast cancer, to investigate the relevant factors of papillary thyroid cancer with breast cancer. Methods: 428 female PTC patients were selected in the retrospective research, of which 327 were patients with simple PTC, 101 were patients with PTC combined breast cancer. We retrospectively analyzed the clinical and pathological data of simple PTC and PTC with breast cancer. Results: There were significant differences in the age, tumor size, extrathyroidal extension rate and neck lymph node metastasis rate between the group of patients with PTC alone and PTC patients with prime breast cancer (p < 0.05). Multifactor Logistic regression analysis showed that the age (OR = 1.056, 95% CI were 1.030~1.082) were positively correlated with the risk of prime breast cancer in female patients with PTC, and the tumor size (OR = 0.466, 95% CI were 0.275~0.725), and neck lymph node metastasis rate (OR = 0.562, 95% CI were 0.324~0.975) were negatively correlated. Conclusion: Older age may increase the risk of breast cancer in PTC patients, and PTC patients with breast cancer have smaller tumors and lower lymph node metastasis than those with PTC only.

Keywords:Papillary Thyroid Carcinomas, Breast Carcinomas, Multiple Primary Carcinomas, Clinicopathological Characteristics, Related Factors

Copyright © 2021 by author(s) and Hans Publishers Inc.

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

1. 引言

多原发癌(multiple primary carcinomas)是指先后或同时发生于同一患者不同器官或组织的两种或两种以上的原发恶性肿瘤。它不仅降低患者的生存预期,还使患者的家庭社会负担进一步加重。因此,研究多原发癌有助于提高对该疾病的认识,指导临床诊治。

临床中,甲状腺、乳腺多原发癌的情况并不罕见,且多发生于女性。最新的全球癌症数据报告显示 [1],2020年在我国和全球女性癌症新发病例中,甲状腺癌分别位于第五位、第四位,乳腺癌则是我国及全球女性发病率及死亡率最高的癌症。甲状腺乳头状癌(Papillary thyroid carcinomas, PTC)作为最常见的甲状腺癌,其预后较好,而乳腺癌严重影响女性的生命健康。已有研究表明 [2] [3],乳腺癌作为甲状腺癌后原发恶性肿瘤的风险增高,原发乳腺癌后再发甲状腺癌风险同样明显增高。本研究旨在探索甲状腺乳头状癌和乳腺癌之间的关系,寻找甲状腺乳头状癌合并乳腺癌的相关因素。

2. 研究对象与方法

2.1. 研究对象

纳入2010年9月至2020年9月就诊于青岛大学附属医院,并经我院手术病理证实为PTC女性患者428例。依据是否共患乳腺癌,将428例患者分为两组,其中单纯PTC患者327例,定义为对照组;共患乳腺癌患者101例,定义为观察组。

纳入标准:1) 于我院手术病理证实为PTC,且在我院规律随访的患者;2) 临床及病理资料较完整。排除标准:1) 男性;2) 合并除外乳腺癌的其他恶性肿瘤疾病;3) 于外院行手术治疗并行病理确诊的PTC;4) 经穿刺活检病理证实为PTC但未行手术治疗的患者;5) 临床资料不完整。本研究为回顾性研究,已经过青岛大学附属医院伦理委员会批准。

2.2. 资料收集

收集对照组和观察组的发病年龄、体重指数(BMI = 体重(kg) ÷ 身高(m)2)、PTC的病理资料(包括肿瘤位置、肿瘤大小(肿瘤的大小使用肿瘤最大病灶的最大直径表示)、单多灶、合并桥本甲状腺炎、甲状腺外侵犯、淋巴结转移。

2.3. 统计学方法

采用SPSS 26.0软件进行统计分析:两组间计数资料用均数 ± 标准差表示,采用t检验进行比较,计量资料用率表示,采用χ2检验或Fisher精确概率法进行比较;采用Logistic逐步回归分析进行甲状腺乳头状癌患者共患乳腺癌影响因素的多因素分析。显著性检验均为双侧检验,P < 0.05具有统计学意义。

3. 结果

3.1. 共患甲状腺乳头状癌、乳腺癌患者的一般资料

本研究纳入101例共患PTC、乳腺癌的患者,其中24例患者的PTC、乳腺癌同时发现(多原发癌的同时发生定义为两种原发癌的发生时间 < 6个月);77例患者的PTC、乳腺癌异时发现(同一患者的两种原发癌发生时间 > 6个月定义为异时发生),其中14例患者先发生PTC,63例患者的乳腺癌先发生。

3.2. 对照组与观察组的临床病理特征比较

观察组患者的年龄、肿瘤大小、包膜浸润率、颈部淋巴结转移率有统计学意义(均P < 0.05)。对照组和观察组患者的平均年龄分别为(44.76 ± 11.52)岁、(50.34 ± 8.91)岁,对照组和观察组甲状腺乳头状癌的肿瘤平均大小分别为(1.20 ± 0.74) cm、(0.83 ± 0.61) cm。患两种癌患者的肿瘤的甲状腺外侵犯率(33.7%)、颈部淋巴结转移率(25.7%)的比例低,且存在显著统计学差异。BMI、多灶率、合并桥本病、远处转移率等差异均无统计学意义(P > 0.05),具体见表1

Table 1. Analysis of clinicopathological characteristics in control and observation groups

表1. 对照组与观察组中的临床病理特征比较

3.3. 甲状腺乳头状癌患者共患乳腺癌的相关因素分析

以是否共患乳腺癌为因变量,赋值如下:未患 = 0,共患 = 1。以年龄、BMI、肿瘤大小、多灶率、甲状腺外侵犯、淋巴结转移为自变量,赋值如下:单病灶 = 0,多病灶 = 1,甲状腺外无侵犯 = 0,甲状腺外侵犯 = 1,淋巴结未转移 = 0,淋巴结转移 = 1。年龄、BMI、肿瘤大小均以原值输入。多因素Logistic回归分析显示,PTC患者共患乳腺癌的风险与年龄(OR = 1.056,95% CI为1.030~1.082)呈正相关,与肿瘤大小(OR = 0.466,95% CI为0.275~0.725)、颈部淋巴结转移率(OR = 0.562,95% CI为0.324~0.975)呈负相关,具体见表2

Table 2. Analysis of the factors associated with papillary thyroid cancer and breast cancer

表2. 甲状腺乳头状癌并发乳腺癌的相关因素分析

4. 讨论

1896年Beatson教授 [4] 首次尝试使用甲状腺提取物治疗转移性乳腺癌,甲状腺癌和乳腺癌之间是否存在一定的联系?这个问题引起了各国学者的注意。在随后的一个多世纪,多位学者 [5] [6] [7] 就甲状腺癌中高发乳腺癌的情况进行了报道,并证实两者间存在一定的联系。我们的研究发现,年龄、肿瘤大小、甲状腺外侵犯、淋巴结转移可能是PTC共患乳腺癌的相关因素。

年龄是PTC临床分期的重要依据 [8],也是PTC患者肿瘤特异性死亡的重要预后因素。据AJCC分期 [9],年龄 < 55岁的PTC患者仅在出现远处转移时才被评定为Ⅱ期。目前已有研究证实 [10] [11] [12],55岁以下的PTC患者的预后优于55岁以上的患者。在本研究纳入的101例共患PTC、乳腺癌的患者中,年龄 < 55岁的病例(68例)明显多于年龄 ≥ 55岁的病例(33例),且具有显著性差异。同时,一项根据美国国立癌症研究所(NCI)的SEER数据库纳入23080例PTC患者的回顾性研究显示 [13],50岁以下患PTC的女性患者再发乳腺癌的风险明显增加。在我们的研究中,与单纯PTC患者相比,共患PTC、乳腺癌患者的平均年龄为50.34岁,较单纯PTC患者的平均年龄大,这与Kuo等人 [14] 得出的结论一致。

肿瘤的高度侵袭性是导致患者不良预后结局的重要原因。PTC的侵袭性主要表现在肿瘤直径大、甲状腺外的侵犯、淋巴结转移等 [15] [16],是目前公认的导致PTC不良预后的重要因素。多位学者 [14] [17] [18] [19] 就SEER数据库中共患PTC和乳腺癌患者的资料进行分析,发现同时患有PTC和乳腺癌的患者与单纯PTC患者相比,共患两种癌患者发病年龄较大,甲状腺肿瘤较小,甲状腺肿瘤存在更好的生物学行为。Park等人 [20] 对甲状腺、乳腺癌患者的临床病理特征进行比较分析时发现,患甲状腺癌的乳腺癌患者的甲状腺肿瘤均为PTC,其肿瘤小,甲状腺外侵犯、淋巴结转移率低。在我们的研究中,同时患有两种癌的患者的甲状腺平均肿瘤直径为0.83 cm,最大肿瘤直径为3 cm,明显小于单纯PTC组。同时,甲状腺、乳腺癌组的甲状腺外侵犯率(33.7%)、颈部淋巴结转移率(25.7%)均低于单纯PTC组,具有统计学差异。在多灶性上,共患两种癌患者的PTC多灶率(32.7%)小于单纯患PTC者,但差别不大。

本研究的局限性在于样本量较小,且仅收集了就诊于青岛大学附属医院的患者资料,未在甲状腺激素、性腺激素、基因等层面进一步分析甲状腺乳头状癌和乳腺癌的关系。另外,由于共患甲状腺、乳腺癌的部分患者随访时间短,后续随访的资料尚不完善,暂未就患者的生存情况进行进一步分析。

总之,甲状腺乳头状癌与乳腺癌存在一定的相关性。临床上,甲状腺乳头状癌患者在复诊过程中应注意筛查乳腺。此外,共患甲状腺乳头状癌和乳腺癌患者的甲状腺肿瘤生物学行为较单纯患甲状腺乳头状癌的患者好,是否存在相关分子机制仍需深入研究。

基金项目

青岛大学“临床医学 + X”项目;BRAFV600E突变对女性甲状腺乳头状癌与乳腺癌共患的致病作用研究。

文章引用

寻增欣,孙梦媛,张静文,李文凤,王 斐. 女性甲状腺乳头状癌患者共患乳腺癌的临床病理特征分析
Analysis of Clinicopathological Characteristics of Papillary Thyroid Cancer with Breast Cancer in Female Patients[J]. 临床医学进展, 2021, 11(12): 5790-5795. https://doi.org/10.12677/ACM.2021.1112856

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  21. NOTES

    *通讯作者。

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