Abstract：
OBJECTIVE: To identify clinical, biological and pathological risk factors for the incidental discovery of papillary thyroid microcarcinomas (PTMCs) in patients undergoing thyroidectomy for presumed benign conditions.
METHODS: Cross sectional, single center study, involving all consecutive patients (N = 3015) who were submitted to thyroid surgery between 2001-2019. All medical files were retrospectively reviewed. A total of 1961 patients in the benign group and 145 patients in PTMC group were analyzed.
RESULTS: No significant differences in age, sex, body mass index, smoking status, thyroid volume or weight and preoperative thyroxine treatment between benign and PTMC groups were observed. Circulating anti- thyroid antibodies, histological thyroiditis and serum thyrotropin (TSH) were significantly associated with PTMC in univariable analysis. Independent risk factors for incidental PTMC by multivariable analysis where possible (OR: 1.51, 95% CI: 0.99-2.28) and certain (OR: 1.74, 95% CI: 1.09-2.78) thyroid autoimmunity (p = 0.002) and higher serum TSH (OR: 1.25, 95% CI: 1.08-1.45, p = 0.03), whereas thyroid lobectomy was associated with a lower risk of PTMC (OR: 0.40, 95% CI: 0.24-0.67, p < 0.001). The most frequent genetic alteration was BRAFV600E mutation, found in 56.3% of PTMC submitted to DNA sequencing. No association between clinical, biological or histological characteristics of PTMC and BRAFV600E mutation was observed.
CONCLUSIONS: Thyroid autoimmunity and higher preoperative serum TSH level were independent predictors of PTMC incidentally discovered during thyroid surgery. Larger prospective studies are needed to better identify possible risk factors for papillary thyroid carcinoma initiation and progression.
METHODS: Cross sectional, single center study, involving all consecutive patients (N = 3015) who were submitted to thyroid surgery between 2001-2019. All medical files were retrospectively reviewed. A total of 1961 patients in the benign group and 145 patients in PTMC group were analyzed.
RESULTS: No significant differences in age, sex, body mass index, smoking status, thyroid volume or weight and preoperative thyroxine treatment between benign and PTMC groups were observed. Circulating anti- thyroid antibodies, histological thyroiditis and serum thyrotropin (TSH) were significantly associated with PTMC in univariable analysis. Independent risk factors for incidental PTMC by multivariable analysis where possible (OR: 1.51, 95% CI: 0.99-2.28) and certain (OR: 1.74, 95% CI: 1.09-2.78) thyroid autoimmunity (p = 0.002) and higher serum TSH (OR: 1.25, 95% CI: 1.08-1.45, p = 0.03), whereas thyroid lobectomy was associated with a lower risk of PTMC (OR: 0.40, 95% CI: 0.24-0.67, p < 0.001). The most frequent genetic alteration was BRAFV600E mutation, found in 56.3% of PTMC submitted to DNA sequencing. No association between clinical, biological or histological characteristics of PTMC and BRAFV600E mutation was observed.
CONCLUSIONS: Thyroid autoimmunity and higher preoperative serum TSH level were independent predictors of PTMC incidentally discovered during thyroid surgery. Larger prospective studies are needed to better identify possible risk factors for papillary thyroid carcinoma initiation and progression.
摘要：
目的：确定临床，在接受甲状腺切除术的患者中偶然发现甲状腺乳头状微小癌（PTMC）的生物学和病理学危险因素。
方法：横截面，单中心研究，涉及2001-2019年间接受甲状腺手术的所有连续患者（N=3015）。对所有医疗档案进行回顾性审查。共分析良性组1961例患者和PTMC组145例患者。
结果：年龄无显著差异，性别,身体质量指数,吸烟状况,观察良性组和PTMC组的甲状腺体积或重量及术前甲状腺素治疗情况.循环抗甲状腺抗体，在单变量分析中，组织学甲状腺炎和血清促甲状腺激素（TSH）与PTMC显着相关。通过多变量分析（OR：1.51，95％CI：0.99-2.28）和某些（OR：1.74，95％CI：1.09-2.78）甲状腺自身免疫（p=0.002）和更高的血清TSH（OR：1.25，95％CI：1.08-1.45，p=0.03），而甲状腺叶切除术与PTMC风险较低相关(OR:0.40,95%CI:0.24-0.67,p<0.001).最常见的遗传改变是BRAFV600E突变，56.3%的PTMC提交DNA测序。临床之间没有关联，观察到PTMC和BRAFV600E突变的生物学或组织学特征。
结论：甲状腺自身免疫和术前血清TSH水平升高是甲状腺手术中偶然发现PTMC的独立预测因素。需要更大的前瞻性研究来更好地确定甲状腺乳头状癌发生和进展的可能危险因素。
方法：横截面，单中心研究，涉及2001-2019年间接受甲状腺手术的所有连续患者（N=3015）。对所有医疗档案进行回顾性审查。共分析良性组1961例患者和PTMC组145例患者。
结果：年龄无显著差异，性别,身体质量指数,吸烟状况,观察良性组和PTMC组的甲状腺体积或重量及术前甲状腺素治疗情况.循环抗甲状腺抗体，在单变量分析中，组织学甲状腺炎和血清促甲状腺激素（TSH）与PTMC显着相关。通过多变量分析（OR：1.51，95％CI：0.99-2.28）和某些（OR：1.74，95％CI：1.09-2.78）甲状腺自身免疫（p=0.002）和更高的血清TSH（OR：1.25，95％CI：1.08-1.45，p=0.03），而甲状腺叶切除术与PTMC风险较低相关(OR:0.40,95%CI:0.24-0.67,p<0.001).最常见的遗传改变是BRAFV600E突变，56.3%的PTMC提交DNA测序。临床之间没有关联，观察到PTMC和BRAFV600E突变的生物学或组织学特征。
结论：甲状腺自身免疫和术前血清TSH水平升高是甲状腺手术中偶然发现PTMC的独立预测因素。需要更大的前瞻性研究来更好地确定甲状腺乳头状癌发生和进展的可能危险因素。
