高危分化型甲状腺癌手术及^(131)I治疗后疗效分类及影响因素分析  

Classification of therapeutic effect and influencing factors in patients with high-risk differentiated thyroid carcinoma after surgery and ^(131)I treatment

作　　者：周倩 王瑞华[1] 刘保平[1] 韩星敏[1] Zhou Qian;Wang Ruihua;Liu Baoping;Han Xingmin(Department of Nuclear Medicine,the First Affiliated Hospital of Zhengzhou University,Henan Provincial Key Medical Laboratory of Molecular Imaging,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院核医学科、河南省分子影像医学重点实验室,450052

出　　处：《中华核医学与分子影像杂志》2021年第11期664-669,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨高危分化型甲状腺癌(DTC)患者手术及131I治疗后疗效分类,并分析影响治疗疗效的相关因素。方法回顾性分析2015年1月到2018年1月就诊于郑州大学第一附属医院的256例高危DTC患者[男70例,女186例;年龄(47.6±12.9)岁]。依据2015年美国甲状腺协会(ATA)指南以及患者术后半年刺激状态下所测数据将患者分为最佳治疗反应(ER)组、疗效不确定(IDR)组、血清学反应欠佳(BIR)组和影像学反应欠佳(SIR)组,BIR和SIR进一步合并为不完全反应(IR)组。采用χ^(2)检验、Fisher确切概率法和Kruskal-Wallis秩和检验比较4个疗效组各临床参数的差异;采用受试者工作特征(ROC)曲线评估131I治疗前刺激性甲状腺球蛋白(psTg)、肿瘤最大径对ER、IR的预测价值。采用多因素logistics回归分析患者ER、IR的独立影响因素。对有B-Raf原癌基因丝/苏氨酸蛋白激酶(BRAF)V006E突变检测结果的亚组单独行疗效的χ^(2)检验。结果ER、IDR、BIR和SIR组的患者比例分别为48.05%(123/256)、20.31%(52/256)、19.53%(50/256)、12.11%(31/256)。4个疗效组患者的性别(χ^(2)=11.495,P=0.008)、肿瘤最大径(H=21.368,P<0.001)、N分期(χ^(2)=42.012,P<0.001)、远处转移(P<0.001)、psTg水平(H=142.829,P<0.001)差异有统计学意义。通过ROC曲线获得的预测ER和IR的psTg界值为5.38μg/L和15.85μg/L,灵敏度分别为79.7%(98/123)和88.9%(72/81),特异性分别为84.2%(112/133)和91.4%(160/175);预测ER和IR的肿瘤最大径的界值为1.45 cm和1.95 cm,灵敏度分别为63.4%(78/123)和53.1%(43/81),特异性分别为66.2%(88/133)和74.3%(130/175)。女性[比值比(OR)=2.305,95%CI:1.041~5.104]、N0期(OR=2.365,95%CI:1.104~5.066)、psTg<5.38μg/L(OR=17.271,95%CI:8.561~34.841)、肿瘤最大径<1.5 cm(OR=2.194,95%CI:1.092~4.409)是ER的独立影响因素;psTg≥15.85μg/L(OR=81.544,95%CI:30.561~217.577)、N1b期(OR=3.617,95%CI:1.276~10.253)、肿瘤最大径>4.0 cm(OR=47.060,95%CI:2.449~904.360)是IR的独立预测因素。SIR�Objective To explore the classification of the therapeutic effect of patients with high-risk differentiated thyroid carcinoma(DTC)after surgery and 131I treatment,and to analyze the relevant factors that affect the therapeutic effect.Methods From January 2015 to January 2018,256 high-risk DTC patients(70 males,186 females;age(47.6±12.9)years)in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed.According to the 2015 American Thyroid Association(ATA)guidelines for therapeutic effect classification standards and the data measured during 6 months postoperative stimulation state,patients were divided into excellent response(ER)group,inderterminate response(IDR)group,biochemical incomplete response(BIR)group and structurally incomplete response(SIR)group,and the latter two groups were further combined into incomplete response(IR)group.χ^(2) test,Fisher exact test and Kruskal-Wallis rank sum test were used to compare the clinical characteristics among the four groups.The receiver operating characteristic(ROC)curve of the relationship with ER and IR was established.Multivariate logistic regression was used to analyze the independent influencing factors of ER and IR.The subgroups with B-Raf proto-oncogene,serine/threonine kinase(BRAF)V006E results were individually tested withχ^(2) test of therapeutic efficacy.Results There were 48.05%(123/256),20.31%(52/256),19.53%(50/256)and 12.11%(31/256)of DTC patients in ER,IDR,BIR and SIR groups respectively.The differences in gender(χ^(2)=11.495,P=0.008),tumor size(H=21.368,P<0.001),N stage(χ^(2)=42.012,P<0.001),distant metastasis(P<0.001)and pre-ablation stimulated thyroglobulin(psTg)level(H=142.829,P<0.001)were statistically significant among the 4 groups.The cut-off values of psTg for predicting ER and IR were 5.38μg/L and 15.85μg/L with the sensitivities of 79.7%(98/123)and 88.9%(72/81),with the specificities of 84.2%(112/133)and 91.4%(160/175)respectively.The cut-off values of tumor size for predicting ER and IR were 1.45 cm and 1.95 cm

关 键 词：甲状腺肿瘤 放射疗法 碘放射性同位素 治疗结果 甲状腺球蛋白 预测 

分 类 号：R736.1[医药卫生—肿瘤]