Analysis Of Central Metastasis And Postoperative Recurrence Factors Of Hashimoto’s Thyroiditis Combined With Papillary Thyroid Microcarcinoma

BackgroundPapillary thyroid carcinoma(PTC)is the most common type of Differentiated thyroid carcinoma(DTC),accounting for about 80%of the DTC.Papillary thyroid microcarcinoma(PTMC)is defined as a Papillary carcinoma with a maximum tumor diameter of 10 mm or less.In recent years,with the advancement of ultrasound technology and the popularization of Fine needle aspiration biopsy(FNAB),the incidence of papillary thyroid microcarcinoma has been increasing year by year,it has become a common malignant thyroid tumor in clinic.Hashimoto’s thyroiditis(HT),also namely chronic lymphocytic thyroiditis,is an inflammatory thyroid disease caused by autoimmune reaction.and its incidence has also shown an increasing trend in recent years.Currently,patients who have HT coexisting with PTMC are common in clinical practice,and the factors affecting the disease,as well as the metastasis and recurrence factors are still in the research stage.The purpose of this study was to analyze the clinical case data of HT patients coexisting with PTMC,to investigate the clinicopathological characteristics of HT coexisting with PTMC,the influencing factors postoperative central lymph nodes metastasis(CLNM)and recurrence of the disease,to guide the clinical diagnosis and treatment.ObjectiveThrough the collection of clinical case data,the clinical data characteristics of all patients were analyzed,to investigate the clinicopathological characteristics of HT coexisting with PTMC.At the same time,further study was conducted to explore the risk factors affecting CLNM and recurrence in patients with this disease.MethodsA total of 935 patients diagnosed as PTMC after thyroid surgery in the thyroid surgery department of our hospital from January 2014 to December 2017 were collected,including 220 patients coexisting with HT and 715 patients without HT.All patients received preoperative cervical ultrasound examination,serum thyroid function and antibody measurement,and some patients received preoperative diagnostic FNAB.All patients had thyroid and lymph nodes pathological results after surgery,and BRAFV600E(hereinafter referred to as BRAF)gene test results after surgeryThe following data were recorded for each patient:gender,age,tumor diameter,number of cancer,the results of the BRAF mutation,external invasion,postoperative central lymph nodes metastasis and lateral lymph nodes metastasis(LLNM)condition,operation method,serum thyroglobulin antibody(Tg-Ab)level,serum thyroid peroxidase antibody(TPO-Ab)level.The difference of data between the two groups was statistically analyzed to explore the clinicopathological characteristics of patients with HT coexisting with PTMC.Patients in the HT coexisting with PTMC group were followed up after surgery,and relevant data were collected.The relapse rate and disease free survival(DFS)were recorded.The clinical data of 220 patients with HT coexisting with PTMC were analyzed to explore the risk factors affecting CLNM and postoperative recurrence.Result1.Through the simple PTMC group and HT coexisting with PTMC single factor analysis of data between the two groups came to the conclusion that HT coexisting with PTMC group has a higher proportion of female,the difference between the two groups was statistically significant(P=0.001),compared with the pure PTMC group,HT coexisting with PTMC are more likely to occur in female patients.2.Analysis risk factors of CLNM in HT coexisting with PTMC:CLNM in HT coexisting with PTMC group was analyzed,single factor chi-square analysis found that the tumor size 6 mm or higher(P=0.001),multifocal(P=0.001),external invasion(P=0.004)were statistically significant.Logistic regression analysis showed that tumor size 6 mm or higher(P=0.012),multifocal(P=0.008),and external invasion(P=0.046)were independent risk factors for CLNM in HT coexisting with PTMC patients.3.Analysis risk factors of recurrence in HT coexisting with PTMC:Log-rank univariate analysis of patients in HT coexisting with PTMC showed that multifocal(P=0.030),external invasion(P=0.014),LLNM(P=0.002)were statistically significant.Cox regression analysis showed that multifocal(P=0.040),external invasion(P=0.019)and LLNM(P=0.017)were independent risk factors for postoperative recurrence in HT coexisting with PTMC patients.Conclusion1.HT coexisting with PTMC is more likely to occur in female patients.Clinical attention should be paid to further HT related examination in female patients who have PTMC to make a clear diagnosis and early and timely treatment.2.Tumor size 6 mm or higher,multifocal and external invasion were independent risk factors for CLNM in HT coexisting with PTMC patients.When preoperative examination of the patient indicated the presence of these factors,central lymph node dissection was required.3.Multifocal,external invasion and LLNM were independent risk factors for postoperative recurrence in HT coexisting with PTMC patients.