Papillāra vairogdziedzera vēža saistība ar labdabīgām vairogdziedzera patoloģijām
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Date
2020
Authors
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Publisher
Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads
Vairākos pētījumos atklāts, ka atsevišķas vairogdziedzera labdabīgas saslimšanas paaugstina vairogdziedzera vēža risku. Visplašāk aprakstītās saistības ar papillāru vairogdziedzera karcinomu ir Hašimoto tireoidītam, multinodulārai strumai, Greivsa slimībai un folikulārai adenomai. Lai gan iepriekš ir konstatēta saikne starp šīm saslimšanām un vairogdziedzera vēzi, netiek piedāvāts konkrēts malignizācijas risks katrai no tām. Specifiskas malignizācijas riska vērtības mudinātu uztvert tās ne tikai kā izolētas saslimšanas, bet arī kā predisponējošus faktorus papillāras vairogdziedzera karcinomas attīstībai.
Mērķis
Iegūt specifiskas paredzošās vērtības, lai izvērtētu un salīdzinātu vairogdziedzera labdabīgo saslimšanu saistību ar papillāru vairogdziedzera karcinomu.
Materiāli un metodes
Pētījums tika plānots kā retrospektīvs šķērsgriezuma modelis. Tika izskatīti Paula Stradiņa Klīniskās Universitātes slimnīcas Patoloģijas institūtā 2018. gadā veiktie patohistoloģiskie atzinumi. Pētījumā iekļauti atzinumi, kuros tika uzstādīta vismaz viena no sekojošajām diagnozēm – papillāra vairogdziedzera karcinoma, Hašimoto tireoidīts, multinodulāra struma, Greivsa slimība un folikulāra adenoma. Datu statistiskā apstrāde tika veikta ar IBM SPSS v22. Tika izmantotas sekojošas analītiskās statistikas metodes: Hī-kvadrāta tests, Binārā loģistiskā regresija. Binārās loģistiskās regresijas modelī iegūtās izredžu attiecības tika pārveidotas par relatīvo risku, izmantojot Zhang et al. izstrādāto vienādojumu.
Rezultāti
Pētījumā tika iekļauti 262 patohistoloģiskie atzinumi. Papillāras vairogdziedzera karcinomas diagnoze tika uzstādīta 80 gadījumos, bet labdabīgu vairogdziedzera saslimšanu diagnožu skaits bija sekojošs: multinodulāra struma – 190, folikulāra adenoma – 45, Hašimoto tireoidīts - 10, Greivsa slimība – 5. Kopējais diagnožu skaits pārsniedz pētījumā apskatīto gadījumu skaitu, jo vairākiem pacientiem pastāv divas vai vairākas diagnozes vienlaikus. Pīrsona Hī-kvadrāta testā tika atklātas statistiski nozīmīgas saistības starp papillāru vairogdziedzera karcinomu un Hašimoto tireoidītu (p=0.006), folikulāru adenomu (p=0.002) un multinodulāru strumu (p=0.001). Greivsa slimība netika iekļauta tālākos aprēķinos statistiski nepietiekamā gadījumu skaita dēļ. Papillārās vairogdziedzera karcinomas relatīvais risks Hašimoto tireoidītam ir 2.31 (95% CI 1.56-3.42); folikulārai adenomai ir 2.09 (CI 1.46-2.72); multinodulārai strumai ir 1.57 (CI 1.32-1.87).
Secinājumi
Hašimoto tireoidīta, folikulāras adenomas un multinodulāras strumas klātbūtne palielina papillāras vairogdziedzera karcinomas relatīvo risku. Vislielākais papillārās vairogdziedzera karcinomas relatīvais risks tika novērots Hašimoto tireoidīta gadījumā. Šie rezultāti norāda, ka pētījumā iekļautās labdabīgās saslimšanas ir nozīmīgi papillāras vairogdziedzera karcinomas riska faktori.
Introduction Several studies have shown a link between papillary thyroid carcinoma and benign thyroid diseases – Hashimoto thyroiditis, multinodular goiter, Graves’ disease and follicular adenoma. Despite previous knowledge, there is limited data on specific predictive values for malignization of each disease. Specific predictive values would illustrate that these diseases are not only isolated entities but also substantial risk factors for malignancy. Aim To obtain specific predictive values of malignization for Hashimoto thyroiditis, multinodular goiter, Graves’ disease and follicular adenoma. Methods A retrospective cross-sectional study design was selected. The study enrols histopathological reviews performed at a single university hospital in 2018. All cases had a histologically verified diagnosis of at least one of the following: papillary thyroid cancer, Hashimoto thyroiditis, multinodular goiter, Graves’ disease or follicular adenoma. Methods of statistical analysis such as Pearson Chi-Square test and binary logistic regression were performed using IBM SPSS 22.0. Results were considered significant if p<0.05. The resulting odds ratios (OR) were converted to relative risk (RR) using a formula proposed by Zhang et al. Results Out of the 262 histopathological cases included in this study, 80 cases had a confirmed papillary thyroid cancer and 182 cases were confirmed to be without thyroid malignancy. Among all the included cases, 5 cases had Graves’ disease, 10 had Hashimoto thyroiditis, 45 had follicular adenoma and 190 had multinodular goiter. Total count of diagnoses exceeds the number of reviewed cases due to some having two or more diagnoses simultaneously. Pearson Chi-Square test reveals that papillary thyroid cancer has statistically significant correlations with Hashimoto thyroiditis (p=0.006), follicular adenoma (p=0.002) and multinodular goiter (p<0.001). Graves’ disease is not included in further calculations as it did not show a statistically significant link with papillary thyroid cancer most likely due to a limited number of cases. The calculated relative risks of papillary thyroid cancer: Hashimoto thyroiditis RR=2.31 (95% CI 1.56-3.42); follicular adenoma RR=2.09 (CI 1.46-2.72); multinodular goiter RR=1.57 (CI 1.32-1.87). Conclusions The presence of Hashimoto thyroiditis, follicular adenoma and multinodular goiter increases the relative risk of papillary thyroid cancer. Hashimoto thyroiditis revealed the largest relative risk of papillary thyroid cancer. These findings illustrate how these benign diseases are not isolated entities but substantial risk factors for developing papillary thyroid cancer.
Introduction Several studies have shown a link between papillary thyroid carcinoma and benign thyroid diseases – Hashimoto thyroiditis, multinodular goiter, Graves’ disease and follicular adenoma. Despite previous knowledge, there is limited data on specific predictive values for malignization of each disease. Specific predictive values would illustrate that these diseases are not only isolated entities but also substantial risk factors for malignancy. Aim To obtain specific predictive values of malignization for Hashimoto thyroiditis, multinodular goiter, Graves’ disease and follicular adenoma. Methods A retrospective cross-sectional study design was selected. The study enrols histopathological reviews performed at a single university hospital in 2018. All cases had a histologically verified diagnosis of at least one of the following: papillary thyroid cancer, Hashimoto thyroiditis, multinodular goiter, Graves’ disease or follicular adenoma. Methods of statistical analysis such as Pearson Chi-Square test and binary logistic regression were performed using IBM SPSS 22.0. Results were considered significant if p<0.05. The resulting odds ratios (OR) were converted to relative risk (RR) using a formula proposed by Zhang et al. Results Out of the 262 histopathological cases included in this study, 80 cases had a confirmed papillary thyroid cancer and 182 cases were confirmed to be without thyroid malignancy. Among all the included cases, 5 cases had Graves’ disease, 10 had Hashimoto thyroiditis, 45 had follicular adenoma and 190 had multinodular goiter. Total count of diagnoses exceeds the number of reviewed cases due to some having two or more diagnoses simultaneously. Pearson Chi-Square test reveals that papillary thyroid cancer has statistically significant correlations with Hashimoto thyroiditis (p=0.006), follicular adenoma (p=0.002) and multinodular goiter (p<0.001). Graves’ disease is not included in further calculations as it did not show a statistically significant link with papillary thyroid cancer most likely due to a limited number of cases. The calculated relative risks of papillary thyroid cancer: Hashimoto thyroiditis RR=2.31 (95% CI 1.56-3.42); follicular adenoma RR=2.09 (CI 1.46-2.72); multinodular goiter RR=1.57 (CI 1.32-1.87). Conclusions The presence of Hashimoto thyroiditis, follicular adenoma and multinodular goiter increases the relative risk of papillary thyroid cancer. Hashimoto thyroiditis revealed the largest relative risk of papillary thyroid cancer. These findings illustrate how these benign diseases are not isolated entities but substantial risk factors for developing papillary thyroid cancer.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Papillāra vairogdziedzera karcinoma; Multinodulāra struma; Hašimoto tireoidīts; Folikulāra adenoma; Greivsa slimība, Papillary thyroid cancer; Multinodular goiter; Hashimoto thyroiditis; Follicular adenoma; Graves’ disease