This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Loh, K.-C. Articles by Yeo, P. P. B. Search for Related Content PubMed PubMed Citation Articles by Loh, K.-C. Articles by Yeo, P. P. B.

Influence of Lymphocytic Thyroiditis on the Prognostic Outcome of Patients with Papillary Thyroid Carcinoma

Division of Endocrinology (K.-C.L., F.S.G., P.P.B.Y.), Department of Medicine, University of California-San Francisco, San Francisco, California 94143; Endocrine Unit (K.-C.L.), Department of Medicine, Tan Tock Seng Hospital, Republic of Singapore; Biostatistics Consultancy Unit (F.D.), National University Medical Institute, Republic of Singapore; and Department of Pathology (T.R.M.), University of California-San Francisco, San Francisco, California 94143

Both the association between lymphocytic thyroiditis (LT) and papillary thyroid carcinoma (PTC), and the prognostic significance of lymphocytic infiltrate in patients with thyroid malignancy, remain controversial. We examine the above relationships by retrospectively reviewing our series of patients treated for differentiated nonmedullary thyroid carcinoma at University of California-San Francisco over a 25-yr period (1970–1995). Of the 631 patients with complete data for analysis, 128 patients (20.3%) showed concomitant histologic evidence of LT and 503 patients (79.7%) had no evidence of LT. Prognostic outcome was assessed using Kaplan-Meier survival plots and analysis of risk factors by Cox’s proportional-hazard modeling. The cohort with LT revealed a higher frequency of PTC (97.7% vs. 87.3%) and female patients (85.2% vs. 66.8%), a lower frequency of extrathyroidal invasion (7.8% vs. 23.3%) and nodal metastases (25.8% vs. 43.3%), and absence of distant metastases (0% vs. 4.8%), respectively, compared with those without LT. At initial surgery, a significantly greater proportion of patients with LT belonged to lower pathological tumor-node-metastasis stages, compared with those without LT (stage 1, 86.7% vs. 73%; stage 2, 4.7% vs. 8.3%; stage 3, 8.6% vs. 15.3%; and stage 4, 0% vs. 3.4%). Over a mean ± SE follow-up period of 11.1 ± 0.4 yr, patients with LT had significantly lower cancer recurrence rate (6.3% vs. 24.1%; P < 0.0001) and cancer mortality rate (0.8% vs. 8.0%; P = 0.001), respectively, compared with those without LT. In summary, our series showed a relatively common occurrence of LT in patients with PTC, and we believed that lymphocytic infiltration developed mainly in response to the tumor itself. We also found a more favorable course of PTC in the presence of LT; this supports the hypothesis that lymphocytic infiltration represents a form of immune reaction to control tumor growth and proliferation.

This article has been cited by other articles:

				W. G. Kim, J. H. Yoon, W. B. Kim, T. Y. Kim, E. Y. Kim, J. M. Kim, J.-S. Ryu, G. Gong, S. J. Hong, and Y. K. Shong Change of Serum Antithyroglobulin Antibody Levels Is Useful for Prediction of Clinical Recurrence in Thyroglobulin-Negative Patients with Differentiated Thyroid Carcinoma J. Clin. Endocrinol. Metab., December 1, 2008; 93(12): 4683 - 4689. [Abstract] [Full Text] [PDF]

				A. Corrias, A. Cassio, G. Weber, A. Mussa, M. Wasniewska, A. Rapa, R. Gastaldi, S. Einaudi, F. Baronio, M. C. Vigone, et al. Thyroid Nodules and Cancer in Children and Adolescents Affected by Autoimmune Thyroiditis Arch Pediatr Adolesc Med, June 1, 2008; 162(6): 526 - 531. [Abstract] [Full Text] [PDF]

				K. D. McCall, N. Harii, C. J. Lewis, R. Malgor, W. Bae Kim, M. Saji, A. D. Kohn, R. T. Moon, and L. D. Kohn High Basal Levels of Functional Toll-Like Receptor 3 (TLR3) and Noncanonical Wnt5a Are Expressed in Papillary Thyroid Cancer and Are Coordinately Decreased by Phenylmethimazole Together with Cell Proliferation and Migration Endocrinology, September 1, 2007; 148(9): 4226 - 4237. [Abstract] [Full Text] [PDF]

				M. Eszlinger, K. Krohn, A. Kukulska, B. Jarzab, and R. Paschke Perspectives and Limitations of Microarray-Based Gene Expression Profiling of Thyroid Tumors Endocr. Rev., May 1, 2007; 28(3): 322 - 338. [Abstract] [Full Text] [PDF]

				M Niedziela Pathogenesis, diagnosis and management of thyroid nodules in children. Endocr. Relat. Cancer, June 1, 2006; 13(2): 427 - 453. [Abstract] [Full Text] [PDF]

				B Jarzab, D Handkiewicz-Junak, and J Wloch Juvenile differentiated thyroid carcinoma and the role of radioiodine in its treatment: a qualitative review Endocr. Relat. Cancer, December 1, 2005; 12(4): 773 - 803. [Abstract] [Full Text] [PDF]

				J. Modi, A. Patel, R. Terrell, R. M. Tuttle, and G. L. Francis Papillary Thyroid Carcinomas from Young Adults and Children Contain a Mixture of Lymphocytes J. Clin. Endocrinol. Metab., September 1, 2003; 88(9): 4418 - 4425. [Abstract] [Full Text] [PDF]

				R. Shah, K. Banks, A. Patel, S. Dogra, R. Terrell, P. A. Powers, C. Fenton, C. A. Dinauer, R. M. Tuttle, and G. L. Francis Intense Expression of the B7-2 Antigen Presentation Coactivator Is an Unfavorable Prognostic Indicator for Differentiated Thyroid Carcinoma of Children and Adolescents J. Clin. Endocrinol. Metab., September 1, 2002; 87(9): 4391 - 4397. [Abstract] [Full Text] [PDF]

				D. M. Tamimi The Association Between Chronic Lymphocytic Thyroiditis and Thyroid Tumors International Journal of Surgical Pathology, April 1, 2002; 10(2): 141 - 146. [Abstract] [PDF]

				S. Scarpino, A. Stoppacciaro, F. Ballerini, M. Marchesi, M. Prat, M. C. Stella, S. Sozzani, P. Allavena, A. Mantovani, and L. P. Ruco Papillary Carcinoma of the Thyroid : Hepatocyte Growth Factor (HGF) Stimulates Tumor Cells to Release Chemokines Active in Recruiting Dendritic Cells Am. J. Pathol., March 1, 2000; 156(3): 831 - 837. [Abstract] [Full Text] [PDF]