术后血清降钙素水平对甲状腺髓样癌患者预后的预测价值  

Postoperative calcitonin level as a predictor for recurrence of medullary thyroid carcinoma after resection

作　　者：赵敬柱 郝伟静 阮先辉 胡琳斐 池嘉栋 李大鹏 郑向前 Zhao Jingzhu;Hao Weijing;Ruan Xianhui;Hu Linfei;Chi Jiadong;Li Dapeng;Zheng Xiangqian(Departments of Thyroid and Neck Tumor,Tianjin Medical University Cancer Institute&Hospital,National Clinical Research Center for Cancer,Tianjin's Clinical Research Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin 300060,China)

机构地区：[1]天津医科大学肿瘤医院甲状腺颈部肿瘤科,国家恶性肿瘤临床医学研究中心,天津市恶性肿瘤临床医学研究中心,天津市肿瘤防治重点实验室,天津300060

出　　处：《中华普通外科杂志》2023年第10期729-733,共5页Chinese Journal of General Surgery

基　　金：国家自然科学基金(82172821,82272721);天津市医学重点学科(专科)建设项目(TJYXZDXK-009A)。

摘　　要：目的评估术后血清降钙素水平在甲状腺髓样癌患者中的预后预测价值。方法收集2011年1月至2019年12月期间首诊于天津医科大学肿瘤医院行手术治疗的146例甲状腺髓样癌患者的临床资料,分析术后血清降钙素与患者无病生存的关系。根据术后6个月血清降钙素值分为血清降钙素正常组和血清降钙素高于正常组。结果146例患者的平均肿瘤直径(1.78±1.22)cm,淋巴结转移81例。术后6个月血清降钙素降至正常者89例,平均肿瘤直径(1.63±1.20)cm,淋巴结转移35例。中位随访56个月,78例患者血清降钙素在正常范围,11例生化复发,3例结构性复发,无死亡患者。血清降钙素高于正常者57例,平均肿瘤直径(1.97±1.22)cm,淋巴结转移46例,远处转移5例,18例发生结构性复发,7例患者死亡。单因素分析结果示,淋巴结转移、TNM分期、术前血清降钙素、淋巴结清扫范围及术后血清降钙素与甲状腺髓样癌患者长期无病生存均有关(均P<0.05)。多因素分析结果示,术后血清降钙素和TNM分期是甲状腺髓样癌患者长期无病生存的独立影响因素(均P<0.05)。结论术后血清降钙素是甲状腺髓样癌患者长期无病生存的有效预测指标。Objective To evaluate postoperative calcitonin level as a prognostic marker in long-term follow-up of medullary thyroid carcinoma(MTC).Methods Clinical data of 146 MTC cases treated at Tianjin Medical University Cancer Institute and Hospital from Jan 2011 to Dec 2019 were reviewed retrospectively.The relationship between postoperative calcitonin and disease-free survival was analyzed.According to the level of calcitonin six months after operation,patients were divided into normal level group and elevated group.Results The median tumor size in those 146 cases was(1.78±1.22)cm,and 81 cases had lymph node metastasis.After 6 months of follow-up,89 cases had normal calcitonin,with median tumor size of(1.63±1.20)cm,and 35 cases had lymph node metastasis.After a median follow-up of 56 months,78 patients had normal calcitonin,11 patients had biochemical relapse,3 patients had structural relapse,and no patients died.57 cases had a higher calcitonin,median tumor size(1.97±1.22)cm,46 cases had lymph node metastasis,5 cases had distant metastasis,18 cases had structural recurrence,and 7 patients died.Univariate analysis showed that lymph node metastasis,TNM stage,preoperative calcitonin,lymph node dissection and postoperative calcitonin were correlated with long-term disease-free survival(all P<0.05).Multivariate analysis showed that postoperative calcitonin and TNM stage were an independent prognosis factor for disease-free survival in MTC patients(all P<0.05).Conclusion Postoperative calcitonin is a independent prognostic marker for long-term disease-free survival in MTC patients.

关 键 词：甲状腺肿瘤 降钙素 淋巴转移 预后 

分 类 号：R736.1[医药卫生—肿瘤]