首次131I治疗前刺激性Tg对儿童及青少年分化型甲状腺癌疗效的预测价值  

Predictive value of stimulated thyroglobulin before the first 131I therapy for children and adolescents with differentiated thyroid carcinoma

作　　者：刘丽娜 张歆玥 刘斌[1] 黄蕤[1] 李林[1] Liu Lina;Zhang Xinyue;Liu Bin;Huang Rui;Li Lin(Department of Nuclear Medicine,West China Hospital of Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院核医学科,成都610041

出　　处：《中华核医学与分子影像杂志》2020年第6期324-328,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨儿童及青少年分化型甲状腺癌(DTC)患者术后首次131I治疗前刺激性甲状腺球蛋白(sTg)预测131I治疗效果的临床价值。方法回顾性分析2009年1月至2018年12月间四川大学华西医院166例儿童及青少年DTC患者[男28例,女138例,年龄(16.5±3.0)岁]临床资料,所有患者均行甲状腺全切及131I治疗。131I治疗后6~12个月进行疗效评价,据治疗结果分为反应完全(ER)组与反应不完全(非ER)组。采用两独立样本t检验、Mann-Whitney U检验、χ2检验或Fisher确切概率法比较2组间临床病理资料,行logistic回归分析影响131I治疗效果的独立因素,应用受试者工作特征(ROC)曲线评估sTg对疗效的预测价值。结果ER患者61例,非ER患者105例。非ER组sTg水平明显高于ER组[52.5(11.8,259.1)和3.0(1.5,9.7)μg/L;z=6.508,P<0.001];2组患者的年龄、初始危险度分层、N分期、M分期、淋巴结转移比例及131I治疗剂量差异也有统计学意义(t=2.622和3.000,z=2.678,χ2=11.432和16.299;均P<0.05)。sTg[比值比(OR)=1.156,P=0.002]及131I治疗剂量(OR=0.958,P=0.048)是影响131I治疗效果的独立因素。ROC曲线分析显示sTg预测疗效的最佳截断值为16.1μg/L,灵敏度和特异性为72.4%(76/105)和96.7%(59/61)。结论sTg可预测儿童及青少年DTC患者首次131I治疗效果,sTg≤16.1μg/L时,获得ER的概率较高。Objective To investigate the predictive value of stimulated thyroglobulin(sTg)before the first 131I therapy for children and adolescents with differentiated thyroid carcinoma(DTC).Methods Between January 2009 and December 2018,a total of 166 children and adolescents DTC patients(28 males,138 females;age(16.5±3.0)years)from West China Hospital of Sichuan University were retrospectively analyzed.All patients underwent total thyroidectomy and 131I therapy.According to the treatment response evaluated 6-12 months after 131I therapy,patients were divided into excellent response(ER)group and incomplete response(non-ER)group.Clinical and pathological characteristics of 2 groups were compared using independent-sample t test,Mann-Whitney U test,χ2 test or Fisher′s exact test.The independent predictors for 131I treatment response were analyzed by logistic regression analysis.The cut-off value of sTg for predicting ER was determined by receiver operating characteristic(ROC)curve analysis.Results Sixty-one patients achieved ER,while treatment response in 105 patients was non-ER.The level of sTg in non-ER group was significantly higher than that in ER group(52.5(11.8,259.1)and 3.0(1.5,9.7)μg/L;z=6.508,P<0.001).In addition,age,risk stratification,N stage,M stage,ratio of invaded lymph nodes and activities of 131I administered were also significantly different between those 2 groups(t=2.611,3.000,z=2.678,χ2=11.432,16.299;all P<0.05).The level of sTg(odds ratio(OR)=1.156,P=0.002)and administered activity of 131I(OR=0.958,P=0.048)were independent predictors for the responses.ROC curve analysis showed that the best cut-off value of sTg for predicting ER was 16.1μg/L with the sensitivity of 72.4%(76/105)and the specificity of 96.7%(59/61).Conclusions sTg has the capability of predicting the response to the first 131I therapy in children and adolescents with DTC.When sTg is lower than 16.1μg/L,the probability of ER increases.

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 儿童 青少年 治疗结果 预测 

分 类 号：R736.1[医药卫生—肿瘤]