PsTg对甲状腺乳头状癌术后功能性淋巴结转移患者131I最佳治疗反应的预测价值

目的:探讨¹³¹I治疗前刺激性甲状腺球蛋白(psTg)水平对甲状腺乳头状癌(PTC)术后功能性残留淋巴结转移且无远处转移患者¹³¹I最佳治疗反应(ER)的预测价值。 方法:回顾性纳入2011年3月至2015年6月间于郑州大学附属肿瘤医院行甲状腺双侧叶全切+淋巴结清扫术后首次行¹³¹I治疗时确诊为功能性残留淋巴结转移且无远处转移的PTC患者72例男22例、女50例,年龄14~76(46.5±14.4)岁;血清甲状腺球蛋白抗体(TgAb)水平均正常]。根据治疗反应评估体系将患者分为ER组和非ER组。采用两独立样本 t检验、 χ²检验、Mann-Whitney U检验比较2组患者的一般临床特征,再进行多因素logistic回归分析;采用ROC曲线评估psTg、转移淋巴结大小(短径)对ER的预测价值。 结果:ER组44例,非ER组28例,2组患者的性别、年龄、临床分期、术后转移淋巴结个数和位置差异均无统计学意义( t=0.82, χ²值:0.16~2.60,均 P>0.05);而美国甲状腺协会(ATA)初始风险分层( χ²=33.38)、转移淋巴结大小( U=296.50)和psTg( U=111.00)差异均有统计学意义(均 P<0.001)。多因素回归分析显示,psTg比值比( OR)=0.047, 95% CI: 0.004~0.500, P=0.011]和转移淋巴结大小( OR=0.146, 95% CI: 0.032~0.666, P=0.013)是影响ER的独立因素,而ATA初始风险分层不是独立因素( OR=0.266, 95% CI: 0.051~1.390, P=0.116)。PsTg、转移淋巴结大小的ROC AUC分别为0.904、0.873;当psTg以20.05 μg/L为界值时,其预测ER的灵敏度和特异性分别为96.4%(27/28)和75.0%(33/44);当转移淋巴结大小以0.75 cm为界值时,其预测ER的灵敏度和特异性分别为78.6%(22/28)和81.8%(36/44)。 结论:PsTg可以较好地预测PTC术后功能性残留淋巴结转移患者¹³¹I疗效,转移淋巴结大小对疗效也有重要影响。

Predictive value of psTg on the excellent response to131I treatment in patients with functional lymph node metastases after papillary thyroid carcinoma surgery

Objective To explore the predictive value of preablative stimulated thyroglobulin(psTg)level before¹³¹I treatment on the excellent response(ER)to¹³¹I treatment in patients with functional residual lymph node metastasis without distant metastasis after papillary thyroid carcinoma(PTC)surgery.Methods From March 2011 to June 2015,72 patients(22 males,50 females,age:14-76(46.5±14.4)years)who were diagnosed with functional lymph node metastasis without distant metastasis at the time of their first¹³¹I treatment after total thyroid bilobectomy+lymph node dissection performed in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively included,and their serum thyroglobulin antibody(TgAb)levels were normal.Patients were divided into ER group and non-ER group according to the treatment response assessment system.Independent sample t test,χ² test,and Mann-Whitney U test were used to compare the basic clinical characteristics between the two groups,and then multivariate logistic regression was performed.The ROC curve was employed to evaluate the predictive value of psTg and lymph node size in¹³¹I treatment response.Results The treatment responses of 44 patients were ER,and those of 28 were non-ER.The differences in gender,age,clinical stage,number and location of postoperative metastatic lymph nodes between ER and non-ER groups were not statistically significant(t=0.82,χ² values:0.16-2.60,all P>0.05),while there were significant differences in American Thyroid Association(ATA)initial risk stratification(χ²=33.38),lymph node size(U=296.50)and psTg(U=111.00,all P<0.001).PsTg(odds ratio(OR)=0.047,95%CI:0.004-0.500,P=0.011)and lymph node size(OR=0.146,95%CI:0.032-0.666,P=0.013)were independent factors affecting ER,whereas ATA initial risk stratification was not an independent factor(OR=0.266,95%CI:0.051-1.390,P=0.116).AUCs for psTg and lymph node size were 0.904 and 0.873,respectively.The cut-off value of psTg was 20.05μg/L with the sensitivity and specificity of 96.4%(27/28)and 75.0%(33/44)respectively,and lymph node size was 0.75 cm with the sensitivity and specificity of 78.6%(22/28)and 81.8%(36/44)respectively.Conclusion PsTg can be used to predict¹³¹I outcomes in patients with functional lymph node metastases after PTC,and lymph node size also has effect on ER.