中高危分化型甲状腺癌患者131碘治疗前刺激性甲状腺球蛋白与治疗后临床转归的相关性
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摘要
目的探讨根据2015ATA指南术后复发风险评估为中高危的分化型甲状腺癌患者(DTC)131碘治疗前刺激性甲状腺球蛋白(sTg)水平与其131碘治疗后临床转归的相关性。方法评估131碘治疗前DTC患者的复发风险,对评估为中高危的患者治疗后临床转归进行随访观察。采用χ~2检验及One-way ANOVA比较治疗反应满意(ER)、可接受(AR)和欠佳(IR)3组患者的临床特征和治疗前sTg水平,ROC曲线及最佳诊断界值点评估sTg对碘治疗后ER的预测价值。结果纳入2016年3月至6月在西安交通大学第一附属医院核医学科接受131碘治疗的DTC复发风险中高危的患者91例,其中男23例,女68例,平均年龄(45.62±11.84)岁,平均接受131碘治疗剂量(121.4±17.3)mCi。因失访等原因最终对78例患者的随访结果进行分析,其中ER 46例、AR 14例、IR 18例。3组患者在年龄、性别、甲状腺腺外侵犯方面差异无统计学意义(P=0.300,0.299,0.274),3组原发病灶直径、颈部淋巴结转移、131碘治疗剂量及术后sTg水平对比具有统计学差异(P=0.018,0.003,<0.001,<0.001)。IR组的sTg水平及131碘治疗剂量水平均显著高于非IR组(P=0.008),而两者在AR组与IR组间无统计学差异(P=0.786)。IR组的sTg界值点为9.69 ng/mL(灵敏度66.7%,特异度86.9%),ROC曲线(AUC=0.897,95%CI:0.826～0.968)。结论 sTg水平对DTC复发风险中高危患者在131碘治疗后的临床转归有预测意义,术后sTg>9.69 ng/mL可作为提示其疗效欠佳的界值点。
Objective To explore the correlation between the treatment of precurative stimulated thyroglobulin(sTg) level and 131 iodine treatment in patients with high-risk differentiated thyroid carcinoma(DTC). Methods After 131 iodine therapy in The First Affiliated Hospital of Xian Jiaotong University from March to June 2016, the patients with high-risk DTC were followed up. We compared the clinical characteristics and pre-treatment sTg level, ROC curve and the evaluation of the best diagnostic boundary value point sTg predictive value of iodine ER after treatment in satisfaction(excellent response, ER),(acceptable response, AR), and(incomplete response, IR) groups by means of chi square test and One-way ANOVA. Results There were 91 high-risk DTC patients treated with iodine-131, including 23 males and 68 females, with an average age of 45.62±11.84 years, with an average of 131 iodine doses of(121.4±17.3)mCi. We analyzed retrospectively the follow-up results of 78 patients(46 cases of ER, 14 cases of AR, and 18 cases of IR). The three groups did not differ significantly in age, gender, or invasion outside the thyroid gland(P=0.300, 0.299, 0.274). however, they differed significantly in primary lesion diameter, neck lymph node metastasis, 131 iodine treatment dose, and postoperative sTg level(P=0.018,0.003,0.000,0.000).The levels of sTg and131 iodine treatment dose were significantly higher in IR group than in non-IR groups(P=0.008),but they had no significant difference between AR and IR groups(P=0.786).In IR group the sTg boundary value point was 9.69 ng/mL(sensitivity 66.7%,specificity 86.9%),ROC curve was 0.897,and 95% CI was 0.826-0.968.Conclusion The level of sTg in patients with moderate-and high-risk DTC is predictive of clinical outcome after 131 iodine treatment.The level of sTg after operation is higher than9.69 ng/mL,which can be used as the cut-off point to indicate the poor curative effect.
Objective To explore the correlation between the treatment of precurative stimulated thyroglobulin(sTg) level and 131 iodine treatment in patients with high-risk differentiated thyroid carcinoma(DTC). Methods After 131 iodine therapy in The First Affiliated Hospital of Xian Jiaotong University from March to June 2016, the patients with high-risk DTC were followed up. We compared the clinical characteristics and pre-treatment sTg level, ROC curve and the evaluation of the best diagnostic boundary value point sTg predictive value of iodine ER after treatment in satisfaction(excellent response, ER),(acceptable response, AR), and(incomplete response, IR) groups by means of chi square test and One-way ANOVA. Results There were 91 high-risk DTC patients treated with iodine-131, including 23 males and 68 females, with an average age of 45.62±11.84 years, with an average of 131 iodine doses of(121.4±17.3)mCi. We analyzed retrospectively the follow-up results of 78 patients(46 cases of ER, 14 cases of AR, and 18 cases of IR). The three groups did not differ significantly in age, gender, or invasion outside the thyroid gland(P=0.300, 0.299, 0.274). however, they differed significantly in primary lesion diameter, neck lymph node metastasis, 131 iodine treatment dose, and postoperative sTg level(P=0.018,0.003,0.000,0.000).The levels of sTg and131 iodine treatment dose were significantly higher in IR group than in non-IR groups(P=0.008),but they had no significant difference between AR and IR groups(P=0.786).In IR group the sTg boundary value point was 9.69 ng/mL(sensitivity 66.7%,specificity 86.9%),ROC curve was 0.897,and 95% CI was 0.826-0.968.Conclusion The level of sTg in patients with moderate-and high-risk DTC is predictive of clinical outcome after 131 iodine treatment.The level of sTg after operation is higher than9.69 ng/mL,which can be used as the cut-off point to indicate the poor curative effect.
引文
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[3] 陈鹏,宋长祥,杜鹏,等.首次131I治疗前刺激性甲状腺球蛋白在预测颈部及远处转移性分化型甲状腺癌的意义[J].中国癌症杂志,2017,27(12):953-958.
[4] CIAPPCUCCINI R,PATEL J,HELLER KS,et al.Stimulated thyroglobulin level at ablation in differentiated thyroid cancer:The impact of treatment preparation modalities and tumor burden[J].Eur J Endocrinol,2014,171(2):247-252.
[5] 林岩松,李娇.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:分化性甲状腺癌131I治疗新进展[J].中国癌症杂志,2016,26(1):1-12.
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[8] 王宗平,伍波,康杰,等.血清甲状腺球蛋白对分化型甲状腺癌的诊断和监测价值[J].中国普外基础与临床杂志,2017,24(3):391-395.
[9] WEBB RC,HOWARD RS,BURCH HB,et al.The utility of serumthyroglobulin measurement at the time of remnant abliation for predicting disease-free status in patients with differentiated thyroid cancer:A meta-analysis involving 3947 patients[J].J Clin Endocrinol Metab,2012,97(8):2754-2763.
[10] 刘永,陈鹏,宋长祥,等.分化型甲状腺癌术后首次131I治疗前刺激性Tg水平与转移灶的关系[J].中国临床医学影像杂志,2017,28(7):471-474.
[11] 林岩松,张彬,梁智勇,等.复发转移性分化型甲状腺癌诊治共识[J].中国癌症杂志,2015,25(7):481-496.
[12] 杨金华,杨佃玉,王彩玲.血清甲状腺球蛋白水平对术后分化型甲状腺癌患者预后的临床意义[J].医学综述,2016,22(17):3516-3519.
[13] 中华医学会内分泌学会,中华医学会外科学分会,中国抗癌协会头颈肿瘤专业委员会,中华医学会核医学分会.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.
[2] 单凤玲,陆汉魁.甲状腺球蛋白实验研究进展与临床应用[J].中国普通外科杂志,2015,26(5):648-654.
[3] 陈鹏,宋长祥,杜鹏,等.首次131I治疗前刺激性甲状腺球蛋白在预测颈部及远处转移性分化型甲状腺癌的意义[J].中国癌症杂志,2017,27(12):953-958.
[4] CIAPPCUCCINI R,PATEL J,HELLER KS,et al.Stimulated thyroglobulin level at ablation in differentiated thyroid cancer:The impact of treatment preparation modalities and tumor burden[J].Eur J Endocrinol,2014,171(2):247-252.
[5] 林岩松,李娇.2015年美国甲状腺学会《成人甲状腺结节与分化型甲状腺癌诊治指南》解读:分化性甲状腺癌131I治疗新进展[J].中国癌症杂志,2016,26(1):1-12.
[6] 戴庆靖,匡安仁.甲状腺球蛋白测定的临床意义及影响因素[J].同位素,2007,20(2):120-125.
[7] 毛敏静,叶廷军,王学锋,等.甲状腺球蛋白检测诊断分化型甲状腺癌的临床意义[J].检验医学,2016,31(3):185-188.
[8] 王宗平,伍波,康杰,等.血清甲状腺球蛋白对分化型甲状腺癌的诊断和监测价值[J].中国普外基础与临床杂志,2017,24(3):391-395.
[9] WEBB RC,HOWARD RS,BURCH HB,et al.The utility of serumthyroglobulin measurement at the time of remnant abliation for predicting disease-free status in patients with differentiated thyroid cancer:A meta-analysis involving 3947 patients[J].J Clin Endocrinol Metab,2012,97(8):2754-2763.
[10] 刘永,陈鹏,宋长祥,等.分化型甲状腺癌术后首次131I治疗前刺激性Tg水平与转移灶的关系[J].中国临床医学影像杂志,2017,28(7):471-474.
[11] 林岩松,张彬,梁智勇,等.复发转移性分化型甲状腺癌诊治共识[J].中国癌症杂志,2015,25(7):481-496.
[12] 杨金华,杨佃玉,王彩玲.血清甲状腺球蛋白水平对术后分化型甲状腺癌患者预后的临床意义[J].医学综述,2016,22(17):3516-3519.
[13] 中华医学会内分泌学会,中华医学会外科学分会,中国抗癌协会头颈肿瘤专业委员会,中华医学会核医学分会.甲状腺结节和分化型甲状腺癌诊治指南[J].中国肿瘤临床,2012,39(17):1249-1272.