Preoperative Thyroid Peroxidase Antibody Predicts Recurrence in Papillary Thyroid Carcinoma: A Consecutive Study With 5,770 Cases

Abstract

BackgroundThyroid autoimmunity is common in papillary thyroid carcinoma (PTC) and was believed to confer a better prognosis; however, controversy still remains. This study aimed to investigate the prognostic value of chronic lymphocytic thyroiditis (CLT) and preoperative thyroid peroxidase antibody (TPOAb) in PTC patients.MethodsA retrospective analysis was performed on 5,770 PTC patients who underwent surgical treatment with pathologically confirmed PTC in our institution between 2012 to 2016. The patients were divided into groups with respect to the coexistence of CLT or preoperative TPOAb levels. The clinicopathological characteristics and disease-free survival (DFS) rates were compared between the groups.ResultsThe coexistence of CLT was likely to have bilateral, multifocal tumors. Particularly, PTC patients with TPOAb++ (>1,000 IU/L) had a larger tumor size (p = 0.007) and higher rates of bilaterality and multifocality than those with TPOAb− (TPOAb< 100 IU/L), while for lymph node metastasis and extrathyroidal extension, there is no statistical difference. Tumor recurrence was found in 15 of 425 (3.5%), 9 of 436 (2.1%), and 56 of 3,519 (1.6%) patients with TPOAb++, TPOAb+, and TPOAb−, respectively (p = 0.017). On univariate analysis, TPOAb++ was correlated with tumor recurrence, with a hazard ratio of 2.20 [95% confidence interval (CI), 1.25–3.89], which remained as an independent risk factor at 1.98 (95% CI, 1.10–3.55) on multivariate analysis. PTC patients with TPOAb++ had the lowest DFS rates (96.5 vs. 97.9 vs. 98.4%, p = 0.020).ConclusionCLT is not a protective factor in PTC patients. We provide initial evidence that the preoperative TPOAb instead predicts recurrence in papillary thyroid carcinoma.

The relationship between thyroid peroxidase antibody and differentiated thyroid cancer: a systematic review and meta-analysis

“…We initially observed that TPOAb+ DTC patients are more likely to exhibit bilateral and multifocal tumors. However, Wang’s study ( 47 ) with a considerably higher weight share in both results had a significant influence. Upon exclusion of the Wang’s study, we found no significant association between TPOAb and DTC multifocality (OR=0.91 [95% CI: 0.56–1.48], p=0.70) and bilaterality (OR=1.41 [95% CI: 0.74–2.66], p=0.29).…”

“…Our analysis focused on five studies ( 40 , 42 , 44 , 46 , 47 ) to determine whether the risk of extrathyroidal extension differs among DTC patients with various TPOAb levels. Among the 1804 TPOAb+ and 7168 TPOAb– patients, little difference in the risk of extrathyroidal extension was found, 12% and 11%, respectively.…”

“…We included three studies ( 40 , 44 , 47 ) to examine the association between TPOAb positivity and the risk of tumor multifocality in DTC patients. Multifocal tumors occurred in 38% of the 1217 TPOAb+ patients compared with 31% of the 4969 TPOAb– patients.…”

“…Our analysis focused on two studies ( 40 , 47 ) to evaluate the association between TPOAb positivity and the risk of tumor recurrence in DTC patients. Tumor recurrence occurred in 4% of the 925 TPOAb+ patients compared with 2% of the 3634 TPOAb– patients.…”

Clinical Prediction Models for Cervical Lymph Node Metastasis of Papillary Thyroid Carcinoma

“…Low TPOAb level is found to be one of the signi cant risk factors of central lymph node metastasis [16,23] . While some studies have shown the opposite result, high TPOAb level (> 100 IU/mL) is an independent risk factor for LNM in PTC [24,25] . Further studies on the effects of TPOAb on LNM and its underlying biological mechanisms are needed.…”