关键词: 桥本甲状腺炎, 甲状腺乳头状癌, 临床病理特征, 危险因素, 外科手术

Abstract: Objective  To analyze the clinicopathological features and surgical strategy of papillary thyroid carcinoma(PTC) with coexistent Hashimoto’s thyroiditis(HT).
Methods  The clinical data of 884 patients with papillary thyroid cancer who underwent the first thyroid surgery in the same diagnosis and treatment group of General Surgery Department of Jiangsu Province Hospital of Chinese Medicine from July 2016 to December 2020 were analyzed retrospectively.The clinicopathological features of PTC patients with coexistent HT and PTC patients without HT were compared,and the risk fastors of central lymph node metastasis in PTC patients coexistent HT were analyzed.
Results  PTC patients with coexistent HT accounted for 30.8% of the total PTC patients.Compared with the PTC patients without HT,PTC patients with coexistent HT had higher proportion of females,younger age,higher proportion of unclear lesion boundary,lower proportion of thyroid capsule invasion and central lymph node metastasis(P<0.05).Multivariate logistic regression analysis showed that younger age,larger tumor diameter and thyroid capsule invasion were associated with higher risk of central lymph node metastasis(OR:0.940,1.644,0.434,P:<0.001,0.027,0.012,respectively).Receiver operating characteristic(ROC) curve analysis showed that age of 39.5 years and maximum tumor diameter of 0.525 cm were cut-off points for central lymph node metastasis in PTC patients with coexistent HT.
Conclusion  PTC with coexistent HT is more common in young women,with unclear boundary,less invasion of thyroid capsule and lower incidence of central lymph node metastasis.Unilateral thyroidectomy and isthmus resection or total thyroidectomy are feasible.Central lymph node dissection can be individualized.For patients younger than 39.5 years old,the maximum diameter of tumor greater than 0.525 cm and thyroid capsule invasion,central lymph node dissection should be routinely performed.

Key words: Hashimoto’s thyroiditis, papillary thyroid carcinoma, clinicopathological features, risk factors, surgical procedure