首次^131I治疗后淋巴结显影伴治疗前刺激性Tg阴性的分化型甲状腺癌的治疗反应及影响因素分析  

Treatment response of differentiated thyroid carcinoma with negative preablative stimulated thyroglobulin and iodine-positive lymph node after the first radioablation and influence factors analysis

作　　者：卢承慧 李娇[1] 刘新峰[1] 王国强[1] 王增华 王叙馥[1] Lu Chenghui;Li Jiao;Liu Xinfeng;Wang Guoqiang;Wang Zenghua;Wang Xufu(Department of Nuclear Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院核医学科,266003

出　　处：《中华核医学与分子影像杂志》2020年第1期21-26,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨甲状腺全切术后、^131I治疗前刺激性甲状腺球蛋白(psTg)阴性伴^131I治疗后SPECT/CT显像示淋巴结显影的分化型甲状腺癌(DTC)患者的治疗反应及其影响因素。方法回顾性纳入2016年5月至2018年10月间在青岛大学附属医院首次行^131I治疗的psTg阴性(<2μg/L)且^131I治疗后5~6 d SPECT/CT显像示淋巴结显影的DTC术后患者108例[男28例、女80例,年龄(45.7±10.4)岁],根据治疗后6~24个月治疗反应将患者分为疗效满意(ER)组与非ER组,采用两独立样本t检验、χ^2检验和Mann-Whitney U检验进行2组间年龄、性别、腺外浸润等多个因素差异的比较,再行多因素logistic回归分析判断治疗反应的影响因素;采用受试者工作特征(ROC)曲线评估显影淋巴结大小(长径)对非ER的预测价值。结果108例患者中82例(75.93%)为ER组,26例(24.07%)为非ER组,2组患者在年龄(t=-2.540,P=0.016)、腺外浸润(χ^2=5.764,P=0.016)、T分期(χ^2=19.857,P<0.001)、N分期(χ^2=14.145,P=0.001)、复发风险分层(χ^2=11.487,P=0.003)、治疗前超声结果(χ^2=44.819,P<0.001)、首次^131I剂量(U=780.0,P=0.018)、显影淋巴结大小(U=184.0,P<0.001)、psTg水平(U=776.0,P=0.037)方面差异有统计学意义。多因素logistic回归分析示,年龄、显影淋巴结大小和治疗前超声结果与治疗反应密切相关,其比值比[OR(95%CI)]分别为:1.123(1.025~1.231)、4.275(1.893~9.653)和260.86(8.123~8376.764)。显影淋巴结大小以5.5 mm为界值时预测非ER的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为100%(26/26)、70.73%(58/82)、77.78%(84/108)、52.00%(26/50)和100%(58/58)。结论首次^131I治疗后淋巴结显影伴治疗前psTg阴性的DTC患者中有部分患者治疗反应未达ER;年龄、治疗前超声、显影淋巴结大小可作为预测其治疗反应的灵敏指标。Objective To investigate the response to^131I therapy and to explore the influence factors in postoperative differentiated thyroid carcinoma(DTC)patients with negative preablative stimulated thyroglobulin(psTg)and iodine-positive lymph node after the first radioablation.Methods From May 2016 to October 2018,108 DTC patients(28 males,80 females,age:(45.7±10.4)years)with negative psTg who underwent^131I treatment for the first time in the Affiliated Hospital of Qingdao University were retrospectively enrolled.All patients had iodine-positive lymph nodes,which were showed by SPECT/CT imaging 5-6 d after^131I treatment.The treatment response was evaluated at 6-24 month after^131I treatment.Patients were divided into excellent response(ER)group and non-excellent response(non-ER)group according to the response to the first^131I treatment.Independent-sample t test,χ^2 test and Mann-Whitney U test were used to analyze differences of factors(e.g.age,gender,extraglandular infiltration)between the 2 groups,and then multivariate logistic regression was performed to find the influence factors for treatment response.The receiver operating characteristic(ROC)curve was employed to evaluate the predictive value of the iodine-positive lymph node size in^131I treatment response.Results A total of 82 patients(75.93%,82/108)achieved ER,and 26(24.07%,26/108)was non-ER patients.There were significant differences in age(t=-2.540,P=0.016),extraglandular infiltration(χ^2=5.764,P=0.016),T stage(χ^2=19.857,P<0.001),N stage(χ^2=14.145,P=0.001),risk stratification of recurrence(χ^2=11.487,P=0.003),ultrasound results before^131I treatment(χ^2=44.819,P<0.001),dose of the first^131I treatment(U=780.0,P=0.018),size(long diameter)of iodine-positive lymph node(U=184.0,P<0.001),and psTg level(U=776.0,P=0.037)between ER and non-ER groups.Multivariate logistic regression showed that age,size of iodine-positive lymph node and ultrasound results before^131I treatment were closely related to^131I treatment response.The odds ratio(OR)values(95%CI)w

关 键 词：甲状腺肿瘤 放射疗法 碘放射性同位素 甲状腺球蛋白 

分 类 号：R73[医药卫生—肿瘤]