Fig. 1Schema of the search strategy.
Fig. 2Forest plots summarizing the risk ratio of the association between Hashimoto thyroiditis and recurrence of papillary thyroid cancer. RR, relative risk; CI, confidence interval.
Table 1Summary of the 71 Studies Included in the Present Meta-Analysis
Study |
Country |
No. of HT/ PTC (%) |
Sex ratio (male), % |
Sex |
Multifocality |
ETE |
Lymph node metastasis |
Distant metastasis |
Recurrence |
Song et al. (2018) [11] |
Korea |
305/1,369 (22.3) |
16.9 |
Y |
Y |
Y |
Y |
|
Ya
|
Cortes et al. (2018) [12] |
Brazil |
45/113 (39.8) |
8.8 |
Y |
|
|
Y |
|
|
Zhang et al. (2017) [13] |
China |
163/438 (37.2) |
22.8 |
Y |
|
|
|
|
|
Sun et al. (2017) [14] |
China |
60/329 (18.2) |
|
|
|
|
|
|
Ya
|
Marotta et al. (2017) [15] |
Italy |
173/301 (57.5) |
15.9 |
Y |
Y |
|
|
|
Y |
Carvalho et al. (2017) [16] |
Brazil |
191/633 (30.2) |
19.9 |
Y |
Y |
Y |
Y |
|
|
Zhu et al. (2016) [17] |
China |
313/1,276 (24.5) |
20.3 |
Y |
Y |
Y |
Y |
|
|
Zhu et al. (2016) [18] |
China |
277/763 (36.3) |
24.2 |
Y |
Y |
|
Y |
|
|
Zeng et al. (2016) [19] |
China |
222/619 (35.9) |
21.8 |
Y |
Y |
Y |
Y |
|
|
Zeng et al. (2016) [20] |
China |
70/578 (12.1) |
15.9 |
Y |
|
Y |
Y |
|
|
Yu et al. (2016) [21] |
China |
48/66 (72.7) |
12.1 |
Y |
|
|
|
|
|
Su et al. (2016) [22] |
China |
56/114 (49.1) |
|
|
Y |
Y |
Y |
|
|
Nam et al. (2016) [23] |
Korea |
22/37 (59.5) |
16.2 |
Y |
Y |
Y |
Y |
Y |
Y |
Siddiqui et al. (2016) [24] |
USA |
93/163 (57.1) |
|
|
|
|
Y |
|
|
Lin et al. (2016) [25] |
China |
26/153 (17) |
|
|
|
|
Y |
|
|
Kim et al. (2016) [26] |
Korea |
1,006/3,332 (30.2) |
22 |
Y |
Y |
Y |
Y |
|
|
Kim et al. (2016) [27] |
Korea |
204/1,780 (11.5) |
16.5 |
Y |
Y |
Y |
Y |
|
|
Dobrinja et al. (2016) [28] |
Italy |
70/160 (43.8) |
32.5 |
Y |
|
Y |
|
|
Y |
Illiadou et al. (2015) [29] |
Greece |
31/108 (28.7) |
24.1 |
Y |
Y |
Y |
Y |
Y |
|
Zhu et al. (2015) [30] |
China |
79/315 (25.1) |
|
|
|
|
|
|
Y |
Wu et al. (2015) [31] |
China |
64/284 (22.5) |
|
|
|
|
Y |
|
|
Park et al (2015) [32] |
Korea |
169/653 (25.9) |
13.9 |
Y |
Y |
|
Y |
|
|
Kwak et al. (2015) [33] |
Korea |
452/1,945 (23.2) |
17.8 |
Y |
Y |
Y |
|
|
Y |
Jiwang et al. (2015) [34] |
China |
5/24 (20.8) |
37.5 |
Y |
Y |
Y |
Y |
|
|
Girardi et al. (2015) [35] |
Brazil |
148/417 (35.5) |
18.7 |
Y |
Y |
Y |
Y |
|
|
Cai et al. (2015) [36] |
China |
229/1,052 (21.8) |
|
|
Y |
Y |
Y |
|
|
Zhang et al. (2014) [37] |
China |
44/144 (30.6) |
26.4 |
Y |
Y |
|
Y |
|
|
Zhang et al. (2014) [38] |
China |
247/1,735 (14.2) |
|
|
Y |
Y |
Y |
|
|
Yang et al. (2014) [39] |
China |
92/291 (31.6) |
|
|
|
|
Y |
|
|
Lang et al. (2014) [40] |
Korea |
331/745 (44.4) |
|
|
|
|
Y |
|
|
Ryu et al. (2014) [41] |
Korea |
49/283 (17.3) |
|
|
|
|
|
|
Ya
|
Liu et al. (2014) [42] |
China |
581/1,722 (33.7) |
20.2 |
Y |
|
|
Y |
|
|
Liang et al. (2014) [43] |
China |
116/529 (21.9) |
|
|
|
|
Y |
|
|
Konturek et al. (2014) [44] |
Poland |
130/773 (16.8) |
11.5 |
Y |
Y |
|
Y |
|
|
Kim et al. (2014) [45] |
Korea |
41/144 (28.5) |
7.6 |
Y |
Y |
Y |
Y |
|
Ya
|
Bircan et al. (2014) [46] |
Turkey |
67/172 (39) |
16.9 |
Y |
Y |
|
Y |
|
|
Giagourta et al. (2014) [47] |
Greece |
441/1,380 (32) |
|
|
Y |
|
Y |
Y |
|
Ye et al. (2013) [48] |
China |
187/1,004 (18.6) |
17.5 |
Y |
|
Y |
Y |
Y |
|
Shin et al. (2013) [49] |
Korea |
64/332 (19.3) |
|
|
|
Y |
|
|
|
Marotta et al. (2013) [50] |
Italy |
54/146 (37) |
20.5 |
Y |
Y |
Y |
Y |
|
|
Kim et al. (2013) [51] |
Korea |
316/1,247 (25.3) |
13.2 |
Y |
Y |
Y |
Y |
|
Y |
Lim et al. (2013) [52] |
Korea |
964/2,947 (32.7) |
20.3 |
Y |
Y |
Y |
Y |
|
|
Lun et al. (2013) [53] |
China |
127/676 (18.8) |
20.6 |
Y |
|
|
Y |
|
|
Jara et al. (2013) [54] |
USA |
226/495 (45.7) |
21 |
Y |
Y |
Y |
Y |
|
|
Dvorkin et al. (2013) [55] |
Israel |
107/753 (14.2) |
|
|
|
Y |
Y |
Y |
Y |
Cordioli et al. (2013) [56] |
Brazil |
35/94 (37.2) |
14.9 |
Y |
Y |
|
Y |
|
|
Yoon et al. (2012) [57] |
Korea |
56/195 (28.7) |
14.9 |
Y |
Y |
Y |
Y |
|
|
Paulson et al. (2012) [58] |
USA |
61/139 (43.9) |
20.1 |
Y |
Y |
Y |
Y |
Y |
|
Jeong et al. (2012) [59] |
Korea |
359/1,357 (26.5) |
13.3 |
Y |
Y |
Y |
Y |
|
Y |
Campos et al. (2012) [60] |
Brazil |
11/41 (26.8) |
17.1 |
Y |
|
|
|
|
|
Villagelin et al. (2011) [61] |
Brazil |
83/119 (69.7) |
13.4 |
Y |
Y |
|
Y |
|
Y |
Nemetz et al. (2011) [62] |
Brazil |
17/52 (32.7) |
7.7 |
Y |
Y |
Y |
|
|
|
Kim et al. (2011) [63] |
Korea |
146/400 (36.5) |
10.8 |
Y |
Y |
Y |
Y |
Y |
|
Huang et al. (2011) [7] |
China |
93/1,997 (4.7) |
17 |
Y |
|
|
Y |
Y |
Y |
Fiore et al. (2011) [64] |
Italy |
112/666 (16.8) |
26.7 |
Y |
|
|
Y |
|
|
Ahn et al. (2011) [65] |
Korea |
58/269 (21.6) |
16.4 |
Y |
Y |
Y |
Y |
|
Y |
Kim et al. (2011) [66] |
Korea |
307/1,028 (29.9) |
20.1 |
Y |
Y |
Y |
Y |
|
|
Mazokopakis et al. (2010) [67] |
Greece |
12/32 (37.5) |
21.9 |
Y |
|
|
|
|
|
Consorti et al. (2010) [68] |
Italy |
25/101 (24.8) |
23.8 |
Y |
Y |
|
Y |
|
|
Muzza et al. (2010) [69] |
Italy |
128/343 (37.3) |
21.9 |
Y |
|
|
Y |
|
|
Kim et al. (2010) [70] |
Korea |
105/323 (32.5) |
15.2 |
Y |
Y |
Y |
|
|
|
French et al. (2010) [71] |
USA |
37/76 (48.7) |
18.4 |
Y |
|
|
Y |
|
|
Gul et al. (2010) [72] |
Turkey |
40/171 (23.4) |
|
|
Y |
Y |
Y |
|
|
Kim et al. (2009) [73] |
Korea |
37/101 (36.6) |
10.9 |
Y |
|
Y |
Y |
|
|
Kim et al. (2009) [8] |
Korea |
214/1,441 (14.9) |
13 |
Y |
Y |
Y |
Y |
|
Ya
|
Larson et al. (2007) [74] |
USA |
43/198 (21.7) |
21.2 |
Y |
|
Y |
Y |
|
|
Kurukahvecioglu et al. (2007) [75] |
Turkey |
37/199 (18.6) |
20.1 |
Y |
Y |
|
Y |
|
|
Kebebew et al. (2001) [76] |
USA |
41/136 (30.1) |
30.1 |
Y |
Y |
|
|
|
Y |
Singh et al. (1999) [77] |
USA |
57/388 (14.7) |
|
|
|
Y |
Y |
Y |
|
Kashima et al. (1998) [78] |
Japan |
281/1,533 (18.3) |
|
|
Y |
Y |
Y |
|
Ya
|
Matsubayashi et al. (1995) [9] |
Japan |
36/95 (37.9) |
7.4 |
Y |
|
|
Y |
|
Ya
|
Table 2Meta-Analyses of the Associations between HT and Clinicopathological Features of Papillary Thyroid Cancer
Variable |
No. of studies |
No. of HT/non-HT |
OR (95% CI) |
Heterogeneity (I2), % |
Female sex |
55 |
9,240/25,966 |
3.13 (2.67–3.68) |
65.1 |
ETE |
38 |
7,311/22,527 |
0.75 (0.70–0.79) |
30.8 |
Multifocality |
42 |
8,129/22,970 |
1.17 (1.05–1.31) |
65 |
LN metastasis |
57 |
9,767/29,378 |
0.82 (0.72–0.94) |
81 |
Distant metastasis |
8 |
957/4,221 |
0.49 (0.32–0.76) |
0 |
Table 3Subgroup Analysis of the Associations between HT and Clinicopathological Features of Papillary Thyroid Cancer by Mean Tumor Size
Variable |
Mean tumor size ≤1 cm |
Mean tumor size >1 cm |
No. of studies |
No. of HT/non-HT |
OR (95% CI) |
No. of studies |
No. of HT/non-HT |
OR (95% CI) |
ETE |
7 |
2,138/6,443 |
0.78 (0.70–0.86) |
25 |
4,617/14,060 |
0.71 (0.66–0.77) |
Multifocality |
9 |
2,335/7,191 |
1.17 (1.05–1.30) |
27 |
5,424/14,814 |
1.19 (1.02–1.38) |
LN metastasis |
11 |
2,576/6,704 |
0.88 (0.59–1.33) |
36 |
6,260/19,507 |
0.78 (0.67–0.91) |
Distant metastasis |
0 |
NA |
NA |
7 |
900/3,890 |
0.52 (0.33–0.81) |
Recurrence |
3 |
809/2,527 |
0.67 (0.31–1.45) |
14 |
1,910/8,133 |
0.44 (0.36–0.55) |
Table 4Subgroup Analysis of the Associations between HT and Clinicopathological Features of Papillary Thyroid Cancer by Study Location
Variable |
Asia |
Non-Asia |
Total |
Europe |
America |
No. of studies |
No. of HT/non-HT |
OR (95% CI) |
No. of studies |
No. of HT/non-HT |
OR (95% CI) |
No. of studies |
No. of HT/non-HT |
OR (95% CI) |
No. of tudies |
No. of HT/non-HT |
OR (95% CI) |
ETE |
26 |
6,266/19,912 |
0.75 (0.70–0.80) |
12 |
1,045/2,615 |
0.75 (0.62–0.89) |
5 |
302/1,036 |
0.74 (0.54–1.02) |
7 |
743/1,579 |
0.75 (0.51–1.05) |
Multifocality |
25 |
6,374/19,289 |
1.19 (1.05–1.34) |
17 |
1,755/3,681 |
1.20 (0.95–1.53) |
9 |
953/2,398 |
1.09 (0.78–1.51) |
8 |
802/1,283 |
1.36 (0.95–1.95) |
LN metastasis |
35 |
7,576/23,949 |
0.81 (0.71–0.93) |
22 |
2,191/5,429 |
0.88 (0.62–1.25) |
11 |
1,172/3,613 |
1.10 (0.59–2.06) |
11 |
1,019/1,816 |
0.68 (0.50–0.93) |
Distant metastasis |
3 |
261/2,173 |
0.63 (0.19–2.01) |
5 |
696/2,048 |
0.47 (0.30–0.76) |
3 |
578/1,639 |
0.53 (0.32–0.87) |
2 |
118/409 |
0.19 (0.03–1.06) |
Recurrence |
14 |
2,365/9,996 |
0.55 (0.43–0.70) |
5 |
474/995 |
0.39 (0.27–0.57) |
3 |
350/864 |
0.37 (0.23–0.59) |
2 |
124/131 |
0.43 (0.22–0.85) |