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.	陳金東. 中國各類癌癥的發病率和死亡率現狀及發展趨勢. 遵義醫學院學報, 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.	殷德濤, 何華楠, 馬潤聲, 等. 甲狀腺乳頭狀癌合并代謝綜合征患者的復發特點. 西安交通大學學報(醫學版), 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, 王廣輝, 王宜軒, 等. GPR30、ERα、cyclinD1在甲狀腺乳頭狀癌組織中的表達. 蚌埠醫學院學報, 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.	張金平, 段降龍, 邱健, 等. 甲狀腺癌術后復發危險因素分析. 西安醫學院, 2018.
15.	G?sior-Perczak D, Pa?yga 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.	劉菊林, 吳躍龍, 李靜, 等. ER、EGFR 在分化型甲狀腺癌中的表達及其臨床意義. 現代生物醫學進展, 2013, (05): 908-910, 927.
22.	董麗儒, 彭濤, 劉楠, 等. ER、PR、Her2/neu 在甲狀腺乳頭狀癌中的表達及臨床意義. 現代腫瘤醫學, 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.	趙莉, 李杰, 袁明剛, 等. 乳頭狀甲狀腺癌ER、PR表達與頸部淋巴結轉移的相關性研究. 世界中醫藥, 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.	劉星偉, 林志東, 李毅. GPER, ERα及ERβ在PTC中的表達與臨床特征關系. 中國現代醫生, 2018, 56(25): 20-22.
27.	沈利軍, 金東嶺, 杜麗敏, 等. 甲狀腺腫瘤雌激素受體亞型及細胞周期素D1的表達及意義. 中國醫學裝備, 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.	曹鐘. 磷酸化應激誘導蛋白1和雌激素受體-α蛋白在甲狀腺乳頭狀癌中的表達及相關性分析. 癌癥進展, 2016, 14(5): 449-451.
32.	王松, 徐德龍. ERα、ERβ和Ki-67在甲狀腺癌中的表達及意義. 河北醫科大學, 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.	顏紅柱, 鄒鈺, 肖鋒, 等. ERα和EZH2在甲狀腺乳頭狀癌中的表達及臨床病理意義. 診斷病理學雜志, 2018, 25(1): 49-54.
35.	陳素琴, 袁海洪, 馮立新. 雌激素受體α、β及基質金屬蛋白酶-9在人甲狀腺乳頭狀癌中的表達及意義. 安徽醫藥, 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.	呂洪林. 分化型甲狀腺癌術后激素水平變化及對促甲狀腺激素抑制治療的指導. 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.	賀小威, 趙越. 雌激素受體在甲狀腺癌中的作用. 中國細胞生物學學報, 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. 陳金東. 中國各類癌癥的發病率和死亡率現狀及發展趨勢. 遵義醫學院學報, 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. 殷德濤, 何華楠, 馬潤聲, 等. 甲狀腺乳頭狀癌合并代謝綜合征患者的復發特點. 西安交通大學學報(醫學版), 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, 王廣輝, 王宜軒, 等. GPR30、ERα、cyclinD1在甲狀腺乳頭狀癌組織中的表達. 蚌埠醫學院學報, 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. 張金平, 段降龍, 邱健, 等. 甲狀腺癌術后復發危險因素分析. 西安醫學院, 2018.
15. G?sior-Perczak D, Pa?yga 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. 劉菊林, 吳躍龍, 李靜, 等. ER、EGFR 在分化型甲狀腺癌中的表達及其臨床意義. 現代生物醫學進展, 2013, (05): 908-910, 927.
22. 董麗儒, 彭濤, 劉楠, 等. ER、PR、Her2/neu 在甲狀腺乳頭狀癌中的表達及臨床意義. 現代腫瘤醫學, 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. 趙莉, 李杰, 袁明剛, 等. 乳頭狀甲狀腺癌ER、PR表達與頸部淋巴結轉移的相關性研究. 世界中醫藥, 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. 劉星偉, 林志東, 李毅. GPER, ERα及ERβ在PTC中的表達與臨床特征關系. 中國現代醫生, 2018, 56(25): 20-22.
27. 沈利軍, 金東嶺, 杜麗敏, 等. 甲狀腺腫瘤雌激素受體亞型及細胞周期素D1的表達及意義. 中國醫學裝備, 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. 曹鐘. 磷酸化應激誘導蛋白1和雌激素受體-α蛋白在甲狀腺乳頭狀癌中的表達及相關性分析. 癌癥進展, 2016, 14(5): 449-451.
32. 王松, 徐德龍. ERα、ERβ和Ki-67在甲狀腺癌中的表達及意義. 河北醫科大學, 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. 顏紅柱, 鄒鈺, 肖鋒, 等. ERα和EZH2在甲狀腺乳頭狀癌中的表達及臨床病理意義. 診斷病理學雜志, 2018, 25(1): 49-54.
35. 陳素琴, 袁海洪, 馮立新. 雌激素受體α、β及基質金屬蛋白酶-9在人甲狀腺乳頭狀癌中的表達及意義. 安徽醫藥, 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. 呂洪林. 分化型甲狀腺癌術后激素水平變化及對促甲狀腺激素抑制治療的指導. 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. 賀小威, 趙越. 雌激素受體在甲狀腺癌中的作用. 中國細胞生物學學報, 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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