Effect Of Preoperative Hashimoto’s Thyroiditis-related Antibody Status On The Development And Metastasis Of Papillary Thyroid Carcinoma

Objective:To investigate the effect of preoperative Hashimoto thyroiditis(HT)-associated antibody status on the development and metastasis of papillary thyroid carcinoma(PTC),and to provide a theoretical basis for clinical decision making,so as to provide more targeted treatment for PTC patients with different antibody status,and to avoid over-and under-medication.Methods:The clinical data of 155 patients diagnosed with PTC who attended the general surgery department of the First Hospital of Shanxi Medical University from January 2020 to December 2020 were retrospectively analyzed and grouped according to their preoperative HT-related antibody status into HT-related antibody-positive and HT-related antibody-negative groups,and the HT-related antibody-positive group was divided into TgAb-only positive,TPOAb-only positive and TgAb-combined with TPOAb-positive subgroups.The age,gender,maximum tumour diameter(cm),whether the tumour was bilateral PTC,whether the tumour was multifocal PTC,whether the tumour was growing outwards from the thyroid tissue,whether the tumour was central lymph node metastasis(CLNM),whether the tumour was lateral lymph node metastasis(LLNM).The data were statistically analyzed using SPSS25.0 statistical software,where the measurement data were expressed as mean ± standard deviation.Comparisons between groups were made by t-test after natural logarithm transformation for measures that did not conform to a normal distribution,t-test for measures that conformed to a normal distribution,and x~2 test for count data.In addition,one-way x~2 test and multi-factor logstic regression analysis were used to explore the CLNM profile of PTC patients,and differences were considered statistically significant for P < 0.05.Results:Among the 155 PTC patients enrolled in the study,25(16.12%)were in the TgAb(+)group alone,14(9.03%)in the TPOAb(+)group alone,44(28.39%)in the TgAb(+)combined with TPOAb(+)group,and 72(46.45%)in the HT-related antibody(-)control group.Statistical analysis of the clinicopathological characteristics of the primary foci in the different subgroups and the control group revealed that the maximum diameter of the tumour was significantly larger in the TgAb(+)group(0.99±0.53 vs 0.65±0.32,P=0.005)and the TgAb combined with TPOAb(+)group(0.84±0.43 vs 0.65±0.32,P=0.013)than in the antibody(-)control group.Statistical analysis between subgroups within the HT-associated antibody(+)group yielded that the maximum tumour diameter in the TgAb(+)group(0.99±0.53 vs 0.56±0.28,P=0.002)and the TgAb combined with TPOAb(+)group(0.84±0.43 vs 0.56±0.28,P=0.013)was significantly larger than that in the TPOAb(+))group.When analysing the number of cases of primary lesions growing outward from the peritoneum in the HT-associated antibody(+)and antibody(-)control groups,it was found that the TgAb(+)group had significantly more tumours than the antibody(-)control group(36% vs 16.67%,P=0.041),while the rest of the subgroups were not statistically significant(P>0.05)in relation to the control and inter-subgroup studies.When studying the multifocality of the primary foci tumour between the different groups,it could be found that the TgAb(+)group and TPOAb(+)group had a higher percentage(32% vs 12.50%,P=0.027),(42.80% vs 12.50%,P=0.006)compared to the antibody(-)control group.When comparing the difference in the proportion of bilateral TC between the different groups,a statistically significant difference was found between the TPOAb(+)group and the antibody(-)control group(50% vs 16.67%,P=0.006).And when studied between subgroups,a statistically significant difference was found between the TPOAb(+)group and the TgAb(+)group(50% vs 12%,P=0.019).When exploring the relationship between different HT-associated antibody status and lymph node metastasis,it was found that HT-associated antibody status was only associated with CLNM and not LLNM.the TgAb(+)group had a higher rate of metastasis of CLNs compared to the antibody(-)control group(68% vs 31.94%,P=0.002)and a higher number of CLNMs(2.04±2.19 vs 0.68± 1.38,P=0.007).Further examining the risk factors associated with CLNM in patients with PTC,in a univariate study we could conclude that patient gender,maximum diameter of primary tumour,invasion of the peritumoral outgrowth,and TgAb(+)alone were correlated with CLNM(P<0.05).Multi-factor logstic regression analysis of the above risk factors showed that male patients,maximum diameter of the primary tumour,invasion of the tegument outward growth,and TgAb(+)alone could be independent risk factors for CLNM in patients with PTC.Conclusion:TgAb(+)was closely associated with the maximum diameter of the primary tumour in PTC,multifocal growth,invasion of the tegument outwards,CLNM,and TPOAb(+)may be associated with the development of bilateral PTC.In addition to TgAb(+)alone,male patients,maximum diameter of primary tumour ≥1 cm,and outward growth of tumour invading the tegument could be independent risk factors for CLNM in PTC patients.In addition,TPOAb(+)may be a limiting factor for progressive tumour enlargement,and patients with PTC combined with TPOAb(+)may have a better prognosis.