高侵袭性病理亚型甲状腺乳头状癌患者初始治疗疗效影响因素分析  

Analysis of the influencing factors of initial treatment efficacy in patients with aggressive variants of papillary thyroid carcinoma

作　　者：韩娜[1] 李娇[1] 卢承慧 王聪聪[1] 刘新峰[1] 王国强[1] 王增华 张莹莹[1] 司增梅 赵子龙 李凤岐 王叙馥[1] Han Na;Li Jiao;Lu Chenghui;Wang Congcong;Liu Xinfeng;Wang Guoqiang;Wang Zenghua;Zhang Yingying;Si Zengmei;Zhao Zilong;Li Fengqi;Wang Xufu(Department of Nuclear Medicine,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,青岛266003

出　　处：《中华转移性肿瘤杂志》2023年第3期223-228,共6页Chinese Journal of Metastatic Cancer

摘　　要：目的探索高侵袭性病理亚型甲状腺乳头状癌(PTC)患者经初始治疗(手术及131I治疗)疗效的影响因素。方法回顾性分析2015年1月至2022年1月手术后于青岛大学附属医院核医学科行131I治疗的高侵袭性病理亚型PTC患者83例, 将初始治疗结果分为疗效满意(ER)组和非ER(NER)组, 比较两组间患者临床病理学及血清学相关指标差异。Kaplan-Meier法比较患者无瘤生存(DFS)并用Log-rank检验差异。建立受试者工作特征曲线获得最佳截断值, 并比较截断值前后DFS差异。结果经过中位随访51个月, 51例患者疗效评价为ER, 32例患者疗效评价为NER。多因素分析结果显示年龄(P=0.001)、肿瘤最大径(P<0.001)、肿瘤腺外侵犯(P<0.001)、刺激性甲状腺球蛋白(sTg;P<0.001)及T分期(P=0.001)是影响初始治疗效果的因素。首次131I治疗前sTg及肿瘤最大径预测疗效不佳的最佳截断值分别为11.88 ng/ml、1.95 cm。sTg<11.88 ng/ml 患者中位DFS明显长于sTg≥11.88 ng/ml患者(P<0.001), 而肿瘤最大径<1.95 cm组患者与≥1.95 cm组患者中位DFS相近(P=0.092)。结论 sTg<11.88 ng/ml、肿瘤最大径<1.95 cm的高侵袭性DTC患者初始治疗疗效较好, 更易获得ER。Objective To investigate the predictive value of the factors associated with the efficacy of initial treatment(surgery and ^(131)I treatment)in patients with aggressive variants of papillary thyroid carcinoma(PTC).Methods A total of 83 patients with aggressive variants of PTC who underwent total thyroidectomy and ^(131)I treatment in the Affiliated Hospital of Qingdao University from January 2015 to January 2022 were retrospectively analyzed.The clinical outcomes of the patients were divided into the excellent response(ER)group and non-ER group.The differences in clinical pathology and serological indicators between these two groups were compared.Kaplan-Meier method was used to compare patients'disease-free survival(DFS)and multiplicity analysis by Log-rank test.Receiver operating characteristic curve was established to obtain the best diagnostic cut off value and compared DFS before and after cutoff values.Results After a median follow-up of 51 months,51 patients were evaluated as ER and 32 patients were evaluated as non-ER.The multiplicity analysis showed that the age(P=0.001),maximum diameter of primary tumor(P<0.001),extra-gland invasion(P<0.001),sTg(P<0.001)and T stage(P=0.001)were the independent risk factors for clinical outcomes in patients with aggressive variants of PTC.The best cut-off values of sTg and maximum diameter of primary tumor were 11.88 ng/m and 1.95 cm.The sTg<11.88 ng/ml was significantly longer than that of patients with sTg≥11.88 ng/ml(P<0.001),while there was no significant difference in median DFS between patients with maximum tumor diameter<1.95 cm and those with≥1.95 cm(P=0.092).Conclusion The patients with aggressive variants of PTC,when sTg level less than 11.88ng/ml before the first ^(131)I treatment and maximum diameter of primary tumor less than 1.95 cm,the patients were more likely to obtain excellent response.

关 键 词：甲状腺乳头状癌 高侵袭性 近距离疗法 甲状腺球蛋白 

分 类 号：R736.1[医药卫生—肿瘤]