乳腺癌再发DTC病人甲状腺功能和ER表达的研究

发布时间：2018-03-06 05:27

  本文选题：乳腺癌　切入点：分化型甲状腺癌　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本课题旨在通过研究乳腺癌术后再发DTC病人甲状腺癌组织中雌激素受体(ER)表达水平和血清甲状腺激素水平进行研究,为DTC的内分泌治疗和预后分析提供理论基础。方法:搜集大连医科大学第一附属医院普外科与大连大学附属中山医院乳腺甲状腺外科2010年1月-2016年12月的住院病人资料,经纳入排除标准筛选后各入组病例数均为43例,包括乳腺癌术后再发DTC病人(双癌组),平均年龄为43.19±12.25岁;首诊DTC组(单癌组),平均年龄41.30±12.22岁;甲状腺良性疾病组(良性组)平均年龄:40.84±7.92岁。每组研究对象资料完整真实,诊断和相应的手术治疗均在相应医院进行,且保持后期随访和根据病情的继续治疗。双癌组根据中华内分泌代谢杂志2012年发布的《甲状腺结节和分化型甲状腺癌诊治指南》进行分类。采用免疫组织化学方法比较乳腺癌术后再发DTC病人癌组织和癌旁组织中ER受体的表达情况及甲状腺激素水平差异,同时分析ER表达情况与DTC癌组织病理学特征之间的关系。结果:1、在双癌组和单癌组部分病人的DTC癌组织中都发现了 ER的阳性表达,其中双癌组ER阳性表达率为25.6%,单癌组为18.6%,且双癌组ER阳性的甲状腺癌病人均来自ER阳性的乳腺癌。2、双癌组部分病人甲状腺癌组织和癌旁组织ER阳性表达率有显著性差异(P0.05)。而在双癌组与单癌组部分患者ER阳性表达率无显著性差异(P0.05)。3、双癌组发生颈部淋巴结转移与未发生颈部淋巴结转移病人的甲状腺癌组织ER阳性表达率分别为54.5%、15.6%,差异有统计学意义(P0.05)。双癌组发生甲状腺包膜侵及与未发生包膜侵及病人的癌组织ER阳性表达率分别为46.7%、14.3%,差异有统计学意义(P＜0.05)。4、双癌组45岁与"g45岁病人甲状腺癌组织的ER阳性表达率分别为30.0%、24.2%癌组织直径1cm与"g1cm病人甲状腺癌组织的ER阳性表达率分别为23.1%、29.4%,癌灶位于双侧叶或峡部与癌灶位于单侧叶病人甲状腺癌组织的ER阳性表达率分别为33.3%、23.5%,以上差异均无统计学意义(P0.05)。5、双癌组、单癌组病人血清TSH与良性组病人血清TSH比较均有显著性差异(P＜0.05),双癌组病人血清TSH和单癌组病人血清TSH比较无显著性差异(P0.05)。三组病人两两比较血清T3、T4均无显著性差异(P0.05)。结论：1、双癌组和单癌组中,部分病人的癌组织ER表达阳性,提示甲状腺乳头状癌可能与雌激素有一定关系,推测部分DTC可能也属于激素依赖性肿瘤,但具体作用机制仍需进一步研究。2、乳腺癌ER阳性可能和部分DTC癌组织ER阳性具有一定联系,推测ER可能是甲状腺癌与乳腺癌发病机制的连接点。3、甲状腺乳头状癌中ER表达阳性可能与癌的转移与侵袭行为相关,与年龄,癌灶数量和位置无关,但相关程度还需大样本临床证据支持。4、甲状腺乳头状癌的发生可能与血清TSH升高有关,与血清T3、T4无关,具体机制还需进一步研究。
[Abstract]:Objective: to study the expression of estrogen receptor ERR and serum thyroid hormone in patients with DTC after breast cancer operation. Methods: the data of patients in general surgery of the first affiliated hospital of Dalian Medical University and breast thyroid surgery of Zhongshan Hospital affiliated to Dalian University from January 2010 to December 2016 were collected. There were 43 cases in each group after inclusion of exclusion criteria, including 43 patients with recurrent DTC after breast cancer operation (mean age 43.19 卤12.25 years old in double cancer group, 41.30 卤12.22 years old in DTC group with first visit), and 41.30 卤12.22 years old in single cancer group (mean age 41.30 卤12.22 years). The average age of benign thyroid disease group (benign group) was: 40.84 卤7.92 years old. The double cancer group was classified according to the guidelines for diagnosis and treatment of thyroid nodules and differentiated thyroid carcinoma published on 2012 by the Chinese Journal of Endocrine Metabolism. Methods to compare the expression of ER receptor and thyroid hormone levels in cancer tissues and adjacent tissues of patients with recurrent DTC after breast cancer operation. At the same time, the relationship between ER expression and pathological features of DTC carcinoma was analyzed. The ER positive expression rate of double cancer group was 25.6 and that of single cancer group was 18.6.The ER positive thyroid cancer patients in double cancer group all came from ER positive breast cancer .2.The ER positive expression rate in thyroid carcinoma and paracancerous tissues of some patients in double cancer group was significant. There was no significant difference in ER positive rate between two cancer groups and one cancer group. The ER positive rate in thyroid cancer tissues of patients with cervical lymph node metastasis or without cervical lymph node metastasis was higher than that of double cancer group. The positive rates of ER were 46.7% and 14.3%, respectively. The difference was statistically significant (P < 0.05). The positive rate of ER in the patients with double cancer was 45 years old and "g45 years old". The positive rates of ER were 46.7% and 14.3%, respectively (P < 0.05), and the difference was statistically significant (P < 0.05). The positive rate of ER expression in both groups was 45 years old and "g 45 years old". The positive rate of ER expression was 46.7% and 14.3% respectively (P < 0.05). The ER positive expression rates of thyroid carcinoma tissues were 30.0% and 24.2%, respectively. The ER positive expression rates of thyroid carcinoma tissues with diameter of 1cm and "g1cm" were 23.1cm and 29.429.429.429..The ER positive expression rates of thyroid cancer tissues in patients with thyroid carcinoma were located in bilateral lobes or in isthmus and in unilateral lobes. The expression rates were 33. 3% and 23. 5%, respectively. There was no significant difference between the two groups (P 0. 05. 5). There was significant difference in serum TSH between patients with single cancer and benign patients (P < 0.05), but there was no significant difference in serum TSH between patients with double cancer and patients with single cancer (P < 0.05). There was no significant difference in serum T _ 3 / T _ 4 between two groups of patients. Conclusion: in the double cancer group and the single cancer group, The positive expression of ER in some patients suggests that thyroid papillary carcinoma may be related to estrogen, and some DTC may also belong to hormone dependent tumors. However, the specific mechanism still needs to be further studied. The ER positive in breast cancer may be related to ER positive in some DTC tissues. It is speculated that ER may be the junction point of thyroid carcinoma and breast cancer. The positive expression of ER in papillary thyroid carcinoma may be related to metastasis and invasive behavior, but not to age, number and location of tumor focus. However, the degree of correlation still needs to be supported by a large sample of clinical evidence. The occurrence of papillary thyroid carcinoma may be related to the elevation of serum TSH, but not to serum T3T4. The specific mechanism needs further study.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R736.1
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本文编号：1573531