体质量指数和雌激素受体与甲状腺乳头状癌转移和复发相关性的meta分析

目的系统评价体质量指数(BMI)、雌激素受体(ER)及其亚型与甲状腺乳头状癌(PTC)淋巴结转移及术后复发的相关性。方法通过检索万方、维普、中国知网、中国生物医学、PubMed、Medline、Embase、Cochrane Library等数据库近6年来有关PTC淋巴结转移、复发与BMI和ER及其亚型关系研究的相关文献。由2名研究者独立进行文献筛选和数据提取,采用Revman 5.3软件进行meta分析。结果共有37篇文献14 596例PTC患者纳入了分析。meta分析结果显示,BMI和ERα与PTC淋巴结转移有关[分别为:OR=1.27,95%CI(1.12,1.42),P<0.000 1;OR=2.68,95%CI(1.86,3.86),P<0.000 01],而ER和ERβ与PTC淋巴结转移无关[分别为:OR=0.87,95%CI(0.56,1.35),P=0.53;OR=1.22,95%CI(0.78,1.89),P=0.39]。ERα与PTC复发有关[OR=1.87,95%CI(1.04,3.35),P=0.04],而BMI与PTC复发无关[OR=1.187 1,95%CI(0.930 0,1.515 3),P=0.17]。结论虽然BMI与PTC复发无关,但高BMI患者容易转移,故对于肥胖患者在手术时淋巴结清扫应更加仔细、全面。ERα阳性增加PTC淋巴结转移和术后复发风险,可作为评估PTC预后的一个不良因素,同时也可为PTC患者术后内分泌治疗提供新思路。

Association of body mass index and estrogen receptor with metastasis and recurrence of papillary thyroid carcinoma: a meta-analysis

Objective To study the correlation of lymph node metastasis and recurrence with body mass index(BMI and estrogen receptor(ER) in papillary thyroid carcinoma(PTC). Method The relevant literatures were retrieved in the past six years through the CNKI, VIP, Wanfang, CBM, PubMed, Medline, Embase, Cochrane Library, etc. databases for meta-analysis of relationship of lymph node metastasis and recurrence of PTC with BMI or ER and its subtypes. Results The meta-analysis showed that the lymph node metastasis of PTC was associated with the BMI and ERα [OR=1.27, 95%CI(1.12, 1.42), P<0.000 1;OR=2.68, 95% CI(1.86, 3.86), P<0.000 01, respectively ], and which not associated with the ER and ERβ [OR=0.87, 95% CI(0.56, 1.35), P=0.53;OR=1.22, 95% CI(0.78,1.89), P=0.39, respectively ]. The ERα was associated with the PTC recurrence [OR=1.87, 95% CI(1.04, 3.35), P=0.04 ], but the BMI was not the risk factor for the recurrence of PTC [OR=1.187 1, 95% CI(0.930 0, 1.515 3), P=0.17 ]. Conclusions Although BMI was not found to be associated with PTC recurrence, high BMI promotes PTC metastasis, so lymph node dissection in obese patients should be more careful and comprehensive. Positive ERα increases risk of lymph node metastasis and recurrence of PTC, which can be used as a negative factor in evaluating prognosis of PTC and provide a new idea for endocrine therapy of PTC.