Obesity’s role in thyroid cancer development is still debated, as well as its association with aggressive histopathological subtypes (AHSs). To clarify the link between Body Mass Index (BMI) and AHS of differentiated thyroid carcinoma (DTC), we evaluated patients who underwent thyroidectomy for DTC from 2020 to 2022 at four European referral centres for endocrine surgery. Based on BMI, patients were classified as normal-underweight, overweight, or obese. AHSs were defined according to 2022 WHO guidelines. Among 3868 patients included, 34.5% were overweight and 19.6% obese. Histological diagnoses were: 93.6% papillary (PTC), 4.8% follicular (FTC), and 1.6% Hürthle cell (HCC) thyroid carcinoma. Obese and overweight patients with PTC had a higher rate of AHSs (p= 0.03), bilateral, multifocal tumours (p= 0.014, 0.049), and larger nodal metastases (p= 0.017). In a multivariate analysis, BMI was an independent predictor of AHS of PTC, irrespective of gender (p= 0.028). In younger patients (<55 years old) with PTC > 1 cm, BMI predicted a higher ATA risk class (p= 0.036). Overweight and obese patients with FTC had larger tumours (p= 0.036). No difference was found in terms of AHS of FTC and HCC based on BMI category. Overweight and obese patients with PTC appear to be at an increased risk for AHS and aggressive clinico-pathological characteristics.
肥胖在甲状腺癌发生发展中的作用及其与侵袭性组织病理学亚型（AHSs）的关联性仍存争议。为阐明体重指数（BMI）与分化型甲状腺癌（DTC）AHS之间的关联，我们对2020至2022年间在欧洲四家内分泌外科转诊中心接受甲状腺切除术的DTC患者进行了评估。根据BMI将患者分为正常/偏轻、超重或肥胖三类。AHSs依据2022年WHO指南进行定义。纳入的3868例患者中，34.5%为超重，19.6%为肥胖。组织学诊断为：93.6%乳头状癌（PTC）、4.8%滤泡状癌（FTC）及1.6%嗜酸细胞癌（HCC）。超重及肥胖PTC患者的AHSs发生率更高（p=0.03），双侧性、多灶性肿瘤比例更高（p=0.014，0.049），淋巴结转移灶体积更大（p=0.017）。多变量分析显示，无论性别如何，BMI是PTC患者发生AHS的独立预测因子（p=0.028）。在肿瘤直径>1cm的年轻PTC患者（<55岁）中，BMI可预测更高的ATA风险分级（p=0.036）。超重及肥胖FTC患者的肿瘤体积更大（p=0.036）。不同BMI分组的FTC与HCC患者在AHS发生率方面无显著差异。超重及肥胖的PTC患者似乎具有更高的AHS风险及更具侵袭性的临床病理特征。
肿瘤(癌症)患者之家