Association of body mass index and estrogen receptor with metastasis and recurrence of papillary thyroid carcinoma: a meta-analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

SU Fenglian ¹ ,  ZHA Wenzhang ² , FAN Rengen ² , XUAN Fuming ¹ , ZHANG Dashuai ¹

1. Yancheng Clinical College of Xuzhou Medical University, Yancheng, Jiangsu 224001, P. R. China;
2. Department of General Surgery, Yancheng City No.1 People’s Hospital, Yancheng, Jiangsu 224001, P. R. China;

Corresponding author：

ZHA Wenzhang, Email: zhawenzhang@sohu.com

Keywords：

papillary thyroid carcinoma; body mass index; obesity; estrogen receptor; recurrence; lymph node metastasis

DOI：

10.7507/1007-9424.201906055

Video：

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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.

Citation： SU Fenglian, ZHA Wenzhang, FAN Rengen, XUAN Fuming, ZHANG Dashuai. Association of body mass index and estrogen receptor with metastasis and recurrence of papillary thyroid carcinoma: a meta-analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2020, 27(2): 173-181. doi: 10.7507/1007-9424.201906055 Copy

1.	陈金东. 中国各类癌症的发病率和死亡率现状及发展趋势. 遵义医学院学报, 2018, 41(6): 653-662.
2.	Ma J, Huang M, Wang L, et al. Obesity and risk of thyroid cancer: evidence from a meta-analysis of 21 observational studies. Med Sci Monit, 2015, 21: 283-291.
3.	Marcello MA, Cunha LL, Batista FA, et al. Obesity and thyroid cancer. Endocr Relat Cancer, 2014, 21(5): T255-T271.
4.	Ding X, Xu Y, Wang Y, et al. Gender disparity in the relationship between prevalence of thyroid nodules and metabolic syndrome components: The SHDC-CDPC Community-Based Study. Mediators Inflamm, 2017, 2017: 8481049.
5.	殷德涛, 何华楠, 马润声, 等. 甲状腺乳头状癌合并代谢综合征患者的复发特点. 西安交通大学学报(医学版), 2018, 39(1): 17-21.
6.	Yu ST, Chen W, Cai Q, et al. Pretreatment BMI is associated with aggressive clinicopathological features of papillary thyroid carcinoma: a multicenter study. Int J Endocrinol, 2017, 2017: 5841942.
7.	Rose DP, Vona-Davis L. Interaction between menopausal status and obesity in affecting breast cancer risk. Maturitas, 2010, 66(1): 33-38.
8.	王畏, 王广辉, 王宜轩, 等. GPR30、ERα、cyclinD1在甲状腺乳头状癌组织中的表达. 蚌埠医学院学报, 2017, 42(10): 1298-1301.
9.	Ahmed RA, Aboelnaga EM. Thyroid cancer in Egypt: histopathological criteria, correlation with survival and oestrogen receptor protein expression. Pathol Oncol Res, 2015, 21(3): 793-802.
10.	Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Appl EngA Aric, 2002, 18(6): 727-734.
11.	Kim HJ, Kim NK, Choi JH, et al. Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer. Clin Endocrinol (Oxf), 2013, 78(1): 134-140.
12.	Trésallet C, Seman M, Tissier F, et al. The incidence of papillary thyroid carcinoma and outcomes in operative patients according to their body mass indices. Surgery, 2014, 156(5): 1145-1152.
13.	Chung YS, Lee JH, Lee YD. Is body mass index relevant to prognosis of papillary thyroid carcinoma? A clinicopathological cohort study. Surg Today, 2017, 47(4): 506-512.
14.	张金平, 段降龙, 邱健, 等. 甲状腺癌术后复发危险因素分析. 西安医学院, 2018.
15.	Gąsior-Perczak D, Pałyga I, Szymonek M, et al. The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer. PLoS One, 2018, 13(10): e0204668.
16.	Feng JW, Yang XH, Wu BQ, et al. Influence of body mass index on the clinicopathologic features of papillary thyroid carcinoma. Ann Otol Rhinol Laryngol, 2019, 128(7): 625-632.
17.	Choi JS, Kim EK, Moon HJ, et al. Higher body mass index may be a predictor of extrathyroidal extension in patients with papillary thyroid microcarcinoma. Endocrine, 2015, 48(1): 264-271.
18.	Liu Z, Maimaiti Y, Yu P, et al. Correlation between body mass index and clinicopathological features of papillary thyroid microcarcinoma. Int J Clin Exp Med, 2015, 8(9): 16472-16479.
19.	Kim SH, Park HS, Kim KH, et al. Correlation between obesity and clinicopathological factors in patients with papillary thyroid cancer. Surg Today, 2015, 45(6): 723-729.
20.	Wu C, Wang L, Chen W, et al. Associations between body mass index and lymph node metastases of patients with papillary thyroid cancer: A retrospective study. Medicine (Baltimore), 2017, 96(9): e6202.
21.	刘菊林, 吴跃龙, 李静, 等. ER、EGFR 在分化型甲状腺癌中的表达及其临床意义. 现代生物医学进展, 2013, (05): 908-910, 927.
22.	董丽儒, 彭涛, 刘楠, 等. ER、PR、Her2/neu 在甲状腺乳头状癌中的表达及临床意义. 现代肿瘤医学, 2015, (24): 3576-3579.
23.	Jalali-Nadoushan MR, Amirtouri R, Davati A, et al. Expression of estrogen and progesterone receptors in papillary thyroid carcinoma. Caspian J Intern Med, 2016, 7(3): 183-187.
24.	赵莉, 李杰, 袁明刚, 等. 乳头状甲状腺癌ER、PR表达与颈部淋巴结转移的相关性研究. 世界中医药, 2017, 12(s1): 297-298.
25.	Che YX, Qin HM, Ding XL, et al. The expression of estrogen receptor in thyroid cancer and its significance. Oncol Transl Med, 2018, 3(3): 127-130.
26.	刘星伟, 林志东, 李毅. GPER, ERα及ERβ在PTC中的表达与临床特征关系. 中国现代医生, 2018, 56(25): 20-22.
27.	沈利军, 金东岭, 杜丽敏, 等. 甲状腺肿瘤雌激素受体亚型及细胞周期素D1的表达及意义. 中国医学装备, 2013, 10(2): 69-71.
28.	Huang Y, Dong W, Li J, et al. Differential expression patterns and clinical significance of estrogen receptor-α and β in papillary thyroid carcinoma. BMC Cancer, 2014, 14: 383.
29.	Ahn HY, Kim MS, Kim MJ, et al. Loss of ERβ expression in papillary thyroid carcinoma is associated with recurrence in young female. Clin Endocrinol (Oxf), 2015, 82(2): 300-306.
30.	Vannucchi G, De Leo S, Perrino M, et al. Impact of estrogen and progesterone receptor expression on the clinical and molecular features of papillary thyroid cancer. Eur J Endocrinol, 2015, 173(1): 29-36.
31.	曹钟. 磷酸化应激诱导蛋白1和雌激素受体-α蛋白在甲状腺乳头状癌中的表达及相关性分析. 癌症进展, 2016, 14(5): 449-451.
32.	王松, 徐德龙. ERα、ERβ和Ki-67在甲状腺癌中的表达及意义. 河北医科大学, 2016.
33.	Eldien MMS, Abdou AG, Rageh T, et al. Immunohistochemical expression of ER-α and PR in papillary thyroid carcinoma. Ecancermedicalscience, 2017, 11: 748.
34.	颜红柱, 邹钰, 肖锋, 等. ERα和EZH2在甲状腺乳头状癌中的表达及临床病理意义. 诊断病理学杂志, 2018, 25(1): 49-54.
35.	陈素琴, 袁海洪, 冯立新. 雌激素受体α、β及基质金属蛋白酶-9在人甲状腺乳头状癌中的表达及意义. 安徽医药, 2018, 22(6): 1112-1115.
36.	Dong WW, Li J, Li J, et al. Reduced expression of oestrogen receptor-β is associated with tumour invasion and metastasis in oestrogen receptor-α-negative human papillary thyroid carcinoma. Int J Exp Pathol, 2018, 99(1): 15-21.
37.	Sturniolo G, Zafon C, Moleti M, et al. Immunohistochemical expression of estrogen receptor-α and progesterone receptor in patients with papillary thyroid cancer. Eur Thyroid J, 2016, 5(4): 224-230.
38.	Choi EK, Park HB, Lee KH, et al. Body mass index and 20 specific cancers: re-analyses of dose-response meta-analyses of observational studies. Ann Oncol, 2018, 29(3): 749-757.
39.	Al-Musa HM. Impact of obesity on serum levels of thyroid hormones among euthyroid saudi adults. J Thyroid Res, 2017, 2017: 5739806.
40.	Marwaha RK, Tandon N, Garg MK, et al. Impact of body mass index on thyroid functions in Indian children. Clin Endocrinol (Oxf), 2013, 79(3): 424-428.
41.	吕洪林. 分化型甲状腺癌术后激素水平变化及对促甲状腺激素抑制治疗的指导. 糖尿病天地, 2019, 16(3): 187-188.
42.	Lu Y, Li J, Li J. Estrogen and thyroid diseases: an update. Minerva Med, 2016, 107(4): 239-244.
43.	贺小威, 赵越. 雌激素受体在甲状腺癌中的作用. 中国细胞生物学学报, 2017, 39(9): 1220-1227.
44.	Rajoria S, Suriano R, Shanmugam A, et al. Metastatic phenotype is regulated by estrogen in thyroid cells. Thyroid, 2010, 20(1): 33-41.
45.	Rubio GA, Catanuto P, Glassberg MK, et al. Estrogen receptor subtype expression and regulation is altered in papillary thyroid cancer after menopause. Surgery, 2018, 163(1): 143-149.
46.	Yi JW, Kim SJ, Kim JK, et al. Upregulation of the ESR1 Gene and ESR ratio (ESR1/ESR2) is associated with a worse prognosis in papillary thyroid carcinoma: The impact of the estrogen receptor α/β expression on clinical outcomes in papillary thyroid carcinoma patients. Ann Surg Oncol, 2017, 24(12): 3754-3762.

1. 陈金东. 中国各类癌症的发病率和死亡率现状及发展趋势. 遵义医学院学报, 2018, 41(6): 653-662.
2. Ma J, Huang M, Wang L, et al. Obesity and risk of thyroid cancer: evidence from a meta-analysis of 21 observational studies. Med Sci Monit, 2015, 21: 283-291.
3. Marcello MA, Cunha LL, Batista FA, et al. Obesity and thyroid cancer. Endocr Relat Cancer, 2014, 21(5): T255-T271.
4. Ding X, Xu Y, Wang Y, et al. Gender disparity in the relationship between prevalence of thyroid nodules and metabolic syndrome components: The SHDC-CDPC Community-Based Study. Mediators Inflamm, 2017, 2017: 8481049.
5. 殷德涛, 何华楠, 马润声, 等. 甲状腺乳头状癌合并代谢综合征患者的复发特点. 西安交通大学学报(医学版), 2018, 39(1): 17-21.
6. Yu ST, Chen W, Cai Q, et al. Pretreatment BMI is associated with aggressive clinicopathological features of papillary thyroid carcinoma: a multicenter study. Int J Endocrinol, 2017, 2017: 5841942.
7. Rose DP, Vona-Davis L. Interaction between menopausal status and obesity in affecting breast cancer risk. Maturitas, 2010, 66(1): 33-38.
8. 王畏, 王广辉, 王宜轩, 等. GPR30、ERα、cyclinD1在甲状腺乳头状癌组织中的表达. 蚌埠医学院学报, 2017, 42(10): 1298-1301.
9. Ahmed RA, Aboelnaga EM. Thyroid cancer in Egypt: histopathological criteria, correlation with survival and oestrogen receptor protein expression. Pathol Oncol Res, 2015, 21(3): 793-802.
10. Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Appl EngA Aric, 2002, 18(6): 727-734.
11. Kim HJ, Kim NK, Choi JH, et al. Associations between body mass index and clinico-pathological characteristics of papillary thyroid cancer. Clin Endocrinol (Oxf), 2013, 78(1): 134-140.
12. Trésallet C, Seman M, Tissier F, et al. The incidence of papillary thyroid carcinoma and outcomes in operative patients according to their body mass indices. Surgery, 2014, 156(5): 1145-1152.
13. Chung YS, Lee JH, Lee YD. Is body mass index relevant to prognosis of papillary thyroid carcinoma? A clinicopathological cohort study. Surg Today, 2017, 47(4): 506-512.
14. 张金平, 段降龙, 邱健, 等. 甲状腺癌术后复发危险因素分析. 西安医学院, 2018.
15. Gąsior-Perczak D, Pałyga I, Szymonek M, et al. The impact of BMI on clinical progress, response to treatment, and disease course in patients with differentiated thyroid cancer. PLoS One, 2018, 13(10): e0204668.
16. Feng JW, Yang XH, Wu BQ, et al. Influence of body mass index on the clinicopathologic features of papillary thyroid carcinoma. Ann Otol Rhinol Laryngol, 2019, 128(7): 625-632.
17. Choi JS, Kim EK, Moon HJ, et al. Higher body mass index may be a predictor of extrathyroidal extension in patients with papillary thyroid microcarcinoma. Endocrine, 2015, 48(1): 264-271.
18. Liu Z, Maimaiti Y, Yu P, et al. Correlation between body mass index and clinicopathological features of papillary thyroid microcarcinoma. Int J Clin Exp Med, 2015, 8(9): 16472-16479.
19. Kim SH, Park HS, Kim KH, et al. Correlation between obesity and clinicopathological factors in patients with papillary thyroid cancer. Surg Today, 2015, 45(6): 723-729.
20. Wu C, Wang L, Chen W, et al. Associations between body mass index and lymph node metastases of patients with papillary thyroid cancer: A retrospective study. Medicine (Baltimore), 2017, 96(9): e6202.
21. 刘菊林, 吴跃龙, 李静, 等. ER、EGFR 在分化型甲状腺癌中的表达及其临床意义. 现代生物医学进展, 2013, (05): 908-910, 927.
22. 董丽儒, 彭涛, 刘楠, 等. ER、PR、Her2/neu 在甲状腺乳头状癌中的表达及临床意义. 现代肿瘤医学, 2015, (24): 3576-3579.
23. Jalali-Nadoushan MR, Amirtouri R, Davati A, et al. Expression of estrogen and progesterone receptors in papillary thyroid carcinoma. Caspian J Intern Med, 2016, 7(3): 183-187.
24. 赵莉, 李杰, 袁明刚, 等. 乳头状甲状腺癌ER、PR表达与颈部淋巴结转移的相关性研究. 世界中医药, 2017, 12(s1): 297-298.
25. Che YX, Qin HM, Ding XL, et al. The expression of estrogen receptor in thyroid cancer and its significance. Oncol Transl Med, 2018, 3(3): 127-130.
26. 刘星伟, 林志东, 李毅. GPER, ERα及ERβ在PTC中的表达与临床特征关系. 中国现代医生, 2018, 56(25): 20-22.
27. 沈利军, 金东岭, 杜丽敏, 等. 甲状腺肿瘤雌激素受体亚型及细胞周期素D1的表达及意义. 中国医学装备, 2013, 10(2): 69-71.
28. Huang Y, Dong W, Li J, et al. Differential expression patterns and clinical significance of estrogen receptor-α and β in papillary thyroid carcinoma. BMC Cancer, 2014, 14: 383.
29. Ahn HY, Kim MS, Kim MJ, et al. Loss of ERβ expression in papillary thyroid carcinoma is associated with recurrence in young female. Clin Endocrinol (Oxf), 2015, 82(2): 300-306.
30. Vannucchi G, De Leo S, Perrino M, et al. Impact of estrogen and progesterone receptor expression on the clinical and molecular features of papillary thyroid cancer. Eur J Endocrinol, 2015, 173(1): 29-36.
31. 曹钟. 磷酸化应激诱导蛋白1和雌激素受体-α蛋白在甲状腺乳头状癌中的表达及相关性分析. 癌症进展, 2016, 14(5): 449-451.
32. 王松, 徐德龙. ERα、ERβ和Ki-67在甲状腺癌中的表达及意义. 河北医科大学, 2016.
33. Eldien MMS, Abdou AG, Rageh T, et al. Immunohistochemical expression of ER-α and PR in papillary thyroid carcinoma. Ecancermedicalscience, 2017, 11: 748.
34. 颜红柱, 邹钰, 肖锋, 等. ERα和EZH2在甲状腺乳头状癌中的表达及临床病理意义. 诊断病理学杂志, 2018, 25(1): 49-54.
35. 陈素琴, 袁海洪, 冯立新. 雌激素受体α、β及基质金属蛋白酶-9在人甲状腺乳头状癌中的表达及意义. 安徽医药, 2018, 22(6): 1112-1115.
36. Dong WW, Li J, Li J, et al. Reduced expression of oestrogen receptor-β is associated with tumour invasion and metastasis in oestrogen receptor-α-negative human papillary thyroid carcinoma. Int J Exp Pathol, 2018, 99(1): 15-21.
37. Sturniolo G, Zafon C, Moleti M, et al. Immunohistochemical expression of estrogen receptor-α and progesterone receptor in patients with papillary thyroid cancer. Eur Thyroid J, 2016, 5(4): 224-230.
38. Choi EK, Park HB, Lee KH, et al. Body mass index and 20 specific cancers: re-analyses of dose-response meta-analyses of observational studies. Ann Oncol, 2018, 29(3): 749-757.
39. Al-Musa HM. Impact of obesity on serum levels of thyroid hormones among euthyroid saudi adults. J Thyroid Res, 2017, 2017: 5739806.
40. Marwaha RK, Tandon N, Garg MK, et al. Impact of body mass index on thyroid functions in Indian children. Clin Endocrinol (Oxf), 2013, 79(3): 424-428.
41. 吕洪林. 分化型甲状腺癌术后激素水平变化及对促甲状腺激素抑制治疗的指导. 糖尿病天地, 2019, 16(3): 187-188.
42. Lu Y, Li J, Li J. Estrogen and thyroid diseases: an update. Minerva Med, 2016, 107(4): 239-244.
43. 贺小威, 赵越. 雌激素受体在甲状腺癌中的作用. 中国细胞生物学学报, 2017, 39(9): 1220-1227.
44. Rajoria S, Suriano R, Shanmugam A, et al. Metastatic phenotype is regulated by estrogen in thyroid cells. Thyroid, 2010, 20(1): 33-41.
45. Rubio GA, Catanuto P, Glassberg MK, et al. Estrogen receptor subtype expression and regulation is altered in papillary thyroid cancer after menopause. Surgery, 2018, 163(1): 143-149.
46. Yi JW, Kim SJ, Kim JK, et al. Upregulation of the ESR1 Gene and ESR ratio (ESR1/ESR2) is associated with a worse prognosis in papillary thyroid carcinoma: The impact of the estrogen receptor α/β expression on clinical outcomes in papillary thyroid carcinoma patients. Ann Surg Oncol, 2017, 24(12): 3754-3762.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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

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