| Objective:To analyze the influence of different levels of Hashimoto’s thyroiditis(HT)related antibodies on the progression and metastasis of thyroid papillary carcinoma(PTC)before operation,so as to guide the establishment of clinical diagnosis and treatment plan in theory.Patients with different antibody status of PTC can carry out more thorough and targeted surgical methods,and assist surgeons to make personalized clinical decisions in the actual operation process in order to prevent under-treatment or over-treatment.Method:The clinical data of 115 PTC patients treated by the General Surgery Department of the 967 th Hospital of the Joint Service Support Force of the People’s Liberation Army from January 2017 to December 2022 were retrospectively analyzed.Based on whether the level of HT-related antibodies(TPOAb,Tgab)was abnormal before operation,the following four groups were divided:(1)HT-related antibodies were all positive;(2)HTrelated antibodies were all negative group;(3)Pure Tg Ab positive group;(4)Pure TPOAb positive group.Statistics were made on sex,age,tumor diameter(cm),central lymph node metastasis(CLNM),whether it was multifocal PTC or whether it was infiltrating the dorsal membrane of the thyroid and whether it spread outward,and the number of metastasis in each group.The total number of lymph nodes(LN)and the amount of LN(LLNM)transferred to the lateral neck.The data processing software is SPSS 27.0,and the measurement value is represented by mean ± standard deviation(SD).Non-normal distribution measurement values are subject to natural logarithm transformation t test,normal distribution measurement values are subject to t test,and count values are subject to Fisher exact probability test or x 2 Inspection.In addition,univariate test and multivariate logistic regression analysis were used to test the CLNM status of PTC patients,and P<0.05 showed significant differences.Results: The study showed that of the 115 PTC patients enrolled,11 were in the pure Tg Ab(+)group,accounting for 9.56%,and 24 were in the pure TPOAb(+)group,accounting for 20.86%.20 people in the combined TPOAb(+)control group,accounting for 17.39%,and 60 people in the HT-associated antibody(-)control group,accounting for 52.17%.Statistical analysis of the clinicopathological characteristics of primary tumors in different groups showed that in terms of the maximum diameter of tumors,the single Tg Ab(+)group(1.46 ± 1.27cm)was significantly larger than the double antibody(-)group(0.84 ± 0.87cm)(P=0.015),and the single Tg Ab(+)TPOAb(+)group(0.83 ±0.46cm)was also significantly larger(P=0.030).The results of the analysis of the HTrelated antibody(+)group and the antibody(-)group around the proportion of tumor invading out of the capsule of the primary focus showed that the proportion of tumor invading out of the capsule was 54.55%,12.50%,20.00% and 20.00% respectively in the pure Tg Ab(+)group,the pure TPOAb(+)group,the double antibody(+)group,and the double antibody(-)group.After comparing the four groups of data,the conclusion was similar to the study of the maximum diameter of the tumor,Compared with pure Tg Ab(+)group,double antibody(-)group and pure TPOAb(+)group,there was significant difference(x 2= 4.179,P=0.041;P=0.015)。 The results of inter-group chi-square test around multifocal primary tumor showed that the probability of multifocal PTC in TPOAb(+)group,Tg Ab(+)group,double antibody(+)group and double antibody(-)group was 20.83%,27.27%,45.00% and 25.00%.Comparing the four groups of data,six groups of comparison results were obtained.It was found that there was no statistically significant difference in all multifocal studies(P>0.05).By analyzing the relationship between the status of various HT-associated antibodies and the number of cases of CLNM and LLNM,as well as the difference between the total number of lymph node dissection and the number of metastatic lymph nodes in the central region,we found that CLN metastasis was significantly different between the pure Tg Ab(+)group and the double antibody(-)group,the double antibody(+)group and the pure TPOAb(+)group,and the pure Tg Ab(+)group and the pure TPOAb(+)group.In terms of the incidence of CLNM,the Tg Ab(+)group alone was significantly higher than the double antibody(-)group and TPOAb(+)group(81.82% vs 31.67%,x 2= 7.802,P=0.005;81.82% vs 16.67%,P=0.000)and the number of lymph nodes in CLNM was more(3.36 ± 3.08 vs 0.97 ± 1.77,P=0.001;3.36 ± 3.08 vs 0.75 ± 2.13,P=0.006).Similarly,in terms of the incidence of CLNM,the dual-antibody(+)group was significantly higher than the TPOAb(+)group(55.00% vs 16.67%,x 2= 5.530,P=0.019)。 In terms of the total amount of LN,the Tg Ab(+)group alone is significantly more than the double antibody(-)group(x 2= 5.498,P=0.019),the total number of lymph nodes in the TPOAb(+)group was also significantly higher than that in the double antibody(-)group(x 2= 2.586,P=0.011)。 In terms of LLN metastasis,only Tg Ab(+)group and double antibody(-)group were significantly different(x 2= 5.498,P=0.019)。 There was no significant difference in CLNM and LLNM between the other four groups(P>0.05).The results showed that there was a close relationship between CLNM and male patients,age<55 years,maximum tumor diameter ≥ 1 cm,simple Tg Ab(+),multiple tumors(P<0.05).Multivariate logistic regression analysis was carried out around these five risk factors.It was found that the independent risk factors of CLNM were male patients,pure Tg Ab(+)and multiple lesions.By analyzing the relationship between the status of various HT-associated antibodies and the number of cases of CLNM and LLNM,as well as the difference between the total number of lymph node dissection and the number of metastatic lymph nodes in the central region,we found that CLN metastasis was significantly different between the pure Tg Ab(+)group and the double antibody(-)group,the double antibody(+)group and the pure TPOAb(+)group,and the pure Tg Ab(+)group and the pure TPOAb(+)group.In terms of the incidence of CLNM,the Tg Ab(+)group alone was significantly higher than the double antibody(-)group and TPOAb(+)group(81.82% vs 31.67%,x 2= 7.802,P=0.005;81.82% vs 16.67%,P=0.000)and the number of lymph nodes in CLNM was more(3.36± 3.08 vs 0.97 ± 1.77,P=0.001;3.36 ± 3.08 vs 0.75 ± 2.13,P=0.006).Similarly,in terms of the incidence of CLNM,the dual-antibody(+)group was significantly higher than the TPOAb(+)group(55.00% vs 16.67%,x 2= 5.530,P=0.019)。 In terms of the total amount of LN,the Tg Ab(+)group alone is significantly more than the double antibody(-)group(x 2= 5.498,P=0.019),the total number of lymph nodes in the TPOAb(+)group was also significantly higher than that in the double antibody(-)group(x 2= 2.586,P=0.011)。 In terms of LLN metastasis,only Tg Ab(+)group and double antibody(-)group were significantly different(x 2= 5.498,P=0.019)。 There was no significant difference in CLNM and LLNM between the other four groups(P>0.05).The results showed that there was a close relationship between CLNM and male patients,age<55years,maximum tumor diameter ≥ 1 cm,simple Tg Ab(+),multiple tumors(P<0.05).Multivariate logistic regression analysis was carried out around these five risk factors.It was found that the independent risk factors of CLNM were male patients,pure Tg Ab(+)and multiple lesions.Conclusion: Tg Ab(+)is closely related to the maximum diameter of PTC primary tumor,tumor invasion capsule,CLNM,the total number of lymph nodes and the number of metastatic lymph nodes in the central region.TPOAb(+)and Tg Ab(+)may have a certain correlation with the total number of LN in the central region.In addition to pure Tg Ab(+),multiple tumors and male patients are independent risk factors of CLNM in PTC patients.In addition,TPOAb(+)may have limitations on CLNM in PTC patients,and TPOAb(+)PTC patients may have better prognosis.Tg Ab(+)is closely related to the maximum diameter of PTC primary tumor,tumor invasion capsule,CLNM,the total number of lymph nodes and the number of metastatic lymph nodes in the central region.TPOAb(+)and Tg Ab(+)may have a certain correlation with the total number of LN in the central region.In addition to pure Tg Ab(+),multiple tumors and male patients are independent risk factors of CLNM in PTC patients.In addition,TPOAb(+)may have limitations on CLNM in PTC patients,and TPOAb(+)PTC patients may have better prognosis. |
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