甲狀腺刺激激素可做為甲狀腺細胞學抽吸為分化不明非典型細胞或分化不明濾泡性病變者是否為甲狀腺癌的預測因子

Serum thyroid-stimulating hormone as a supplementary predictor of differentiated thyroid cancer in thyroid nodules with atypia or follicular lesion of undetermined significance

曾寶玉(Pao-Yu Tseng)

指導教授 ： 王博輝

中山醫學大學/醫學院/醫學研究所/碩士(2017年)

摘要

研究目的：
甲狀腺細胞學抽吸結果為分化不明非典型細胞(atypia of undetermined significance)或分化不明濾泡性病變者(follicular lesion of undetermined significance)有5-15%的機率為惡性腫瘤，臨床上病人可選擇追蹤或是直接手術；但近年來新的報告顯示這類患者有手術者6-96.7 %者為癌症，故如何判定病人為高危險群而需要手術就變得相當重要。有很多的資料顯示甲狀腺刺激激素(TSH)的上升與甲狀腺癌的風險增加有關，因此這篇研究的目的是要探討甲狀腺刺激激素的濃度是否可以輔助超音波及臨床危險因子做為這類患者甲狀腺癌的預測因子。
研究方法及資料：
本研究在彰化基督教醫院進行，採用回溯性資料收集；研究對象為2006/1~2017/1間所有甲狀腺結節患者接受手術者其術前細針抽吸結果為分化不明非典型細胞或分化不明濾泡性病變的人。我們以病理組織報告來確認良惡性，惡性患者我們僅收入分化型甲狀腺癌患者。每位個案我們收集距離細針抽吸前後3個月內的血清甲狀腺刺激激素濃度、年齡、性別、腫瘤大小、超音波影像、癌症期別、病理報告等，經統計分析後找出與甲狀腺癌相關的獨立變項。
研究結果：
研究案例一共157人，其中良性患者66人，惡性患者91人。多元邏輯斯迴歸分析顯示在分化不明非典型細胞或分化不明濾泡性病變者身上血清甲狀腺刺激激素濃度與甲狀腺癌有顯著正相關(p =0.0014)。惡性組的平均甲狀腺刺激激素濃度顯著高於良性組( 1.68 ± 1.05 mIU/L vs 1.06 ± 0.74 mIU/L， p =0.0001)；而當與甲狀腺刺激激素濃度小於0.45 mIU/L者的惡性機率14%相比，甲狀腺刺激激素濃度大於等於1.8 mIU/L時，惡性機率為78%，有顯著差異(p < 0.0001)。此外年紀較輕、結節大小較小及超音波影像有惡性徵者也與甲狀腺癌有顯著相關(p <0.05)。最後在惡性患者中再進一步分析，顯著較高的甲狀腺刺激激素濃度也在T3患者(T3對T1，p =0.0476)跟側頸部淋巴轉移的患者(N1b對N0，p =0.0414)身上被觀察到。
結論與建議：
甲狀腺細胞學抽吸結果為分化不明非典型細胞或分化不明濾泡性病變者，其血清甲狀腺刺激激素濃度越高者甲狀腺癌的風險越高，未來可能可以利用甲狀腺刺激激素濃度的資訊來輔助這類患者決定是否手術。

關鍵字

甲狀腺刺激激素 ； 甲狀腺癌 ； 分化不明非典型細胞 ； 分化不明濾泡性病變

並列摘要

Objective：
Higher serum thyroid-stimulating hormone (TSH) level is associated with a greater risk of thyroid cancer in patients with thyroid nodular goiter. The aim of this study is to examine serum TSH as a malignant predictor in thyroid nodules with atypia of undetermined significance (AUS) or follicular lesion of undetermined significance (FLUS).
Methods and Materials：
We retrospectively collected thyroid nodular patients who had received thyroidectomy in Changhua Christian Hospital from January 2006 to January 2017 and whose preoperative fine-needle aspiration cytological reports as AUS or FLUS. Patients were classified into benign or malignant group according to their surgical pathologic results. In the malignant group, only differentiated thyroid cancers were included. Serum TSH levels within three months before or after fine-needle aspiration, ultrasound pictures and clinical parameters were recorded. Then we analyzed the association of different variables with thyroid cancer.
Results：
Totally 157 patients were consecutively enrolled in this study. 66 were benign nodules and 91 were malignant cases. Based on multivariable analysis, it showed a positive association of serum TSH with malignancy in nodules with AUS/FLUS (p =0.0014). The mean TSH level was significantly higher in the malignant group than that of the benign group ( 1.68 ± 1.05 mIU/L vs 1.06 ± 0.74 mIU/L；p = 0.0001). The rate of malignancy was 78% in patients at TSH ≧1.8 mIU/L as compared to 14% in those at TSH < 0.45 mIU/L (p < 0.0001). Younger age, smaller nodular size and nodule with suspicious ultrasound pictures were also significantly associated with malignancy using logistic regression analyses (p < 0.05). In addition, significantly higher TSH levels were noted in T3 stage (T3 vs. T1；p = 0.0476) and patients with lateral neck lymph node metastasis (N1b vs. N0；p = 0.0414) among malignant cases.
Conclusion and Suggestion：
The risk of differentiated thyroid cancer increases with elevated serum TSH level in thyroid nodules with AUS/FLUS. Higher serum TSH concentration may be considered as a supplementary indicator in determining surgery for patients with these nodules.

並列關鍵字

thyroid-stimulating hormone(TSH) ； thyroid cancer ； atypia of undetermined significance (AUS) ； follicular lesion of undetermined significance (FLUS)

參考文獻

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