分化型甲状腺癌术后TSH抑制治疗后复发转移的影响因素  

Risk of Recurrence and Metastasis After Postoperative TSH Suppression Therapy for Differentiated Thyroid Cancer

作　　者：王宁[1] 刘金彪[1] 乔楠 WANG Ning;LIU Jinbiao;QIAO Nan(Department of Thyroid Surgery,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学第一附属医院甲状腺外科,河南洛阳471003

出　　处：《河南医学研究》2023年第24期4468-4473,共6页Henan Medical Research

摘　　要：目的探讨分化型甲状腺癌(DTC)术后促甲状腺激素(TSH)抑制疗法治疗失败发生复发转移的相关因素。方法回顾性选取2017年1月至2020年4月医院收治的282例DTC患者,均于手术后接受TSH抑制疗法治疗,统计术后3 a复发转移情况,分析复发转移的相关影响因素,构建列线图预测模型。结果282例DTC患者术后3 a复发转移发生率为14.54%(41/282);复发转移组与未复发转移组病灶数量、肿瘤直径、临床分期、术前淋巴结转移、术后复发危险分层、术后甲状腺球蛋白(Tg)水平、左旋甲状腺素剂量、^(131)I治疗比较,差异有统计学意义(P<0.05);logistic回归分析显示,病灶数量、肿瘤直径、临床分期、术前淋巴结转移、术后复发危险分层、术后Tg水平是复发转移的独立危险因素,左旋甲状腺素剂量、^(131)I治疗是治疗失败发生复发转移的独立保护因素(P<0.05);列线图模型预测治疗失败发生复发转移的曲线下面积为0.943(95%CI:0.883~0.977);校准曲线显示,该模型一致性指数为0.843,且模型拟合度较好(P=0.441)。结论病灶数量、肿瘤直径、临床分期、术前淋巴结转移、术后复发危险分层、术后Tg水平、左旋甲状腺素剂量、^(131)I治疗均为DTC术后TSH抑制治疗后发生复发转移的预测因子,所建立的列线图预测模型具有较高风险预测价值。Objective To investigate the factors associated with and predictors of recurrence and metastasis occurring after postoperative thyroid hormone(TSH)suppressive therapy failure in differentiated thyroid cancer(DTC).Methods A retrospective analysis was conducted on 282 patients with DTC admitted to the hospital from January 2017 to April 2020,who received TSH suppression therapy after surgery.The recurrence and metastasis status of the patients were analyzed for 3 years after surgery,and the relevant factors affecting recurrence and metastasis were analyzed.A nomographic prediction model was constructed.Results The incidence of recurrence and metastasis in 282 DTC patients 3 years after surgery was 14.54%(41/282).The number of lesions,tumor diameter,clinical stage,preoperative lymph node metastasis,postoperative risk stratification for recurrence,postoperative thyroglobulin(Tg)level,levothyroxine dose,and^(131)I therapy were the influencing factors for recurrent metastases occurring with treatment failure(P<0.05).Logistic regression analysis showed that the number of lesions,tumor diameter,clinical stage,preoperative lymph node metastasis,postoperative risk stratification for recurrence,and postoperative Tg level were independent risk factors for recurrent metastasis in treatment failure,and levothyroxine dose and^(131)I treatment were independent protective factors for recurrent metastasis in treatment failure(P<0.05).The area under the curve for predicting treatment failure,recurrence and metastasis of the column chart model was 0.943(95%CI:0.883-0.977).The calibration curve showed that the model consistency index was 0.843,and the model fit was good(P=0.441).Conclusion Number of lesions,tumor diameter,clinical stage,preoperative lymph node metastasis,postoperative risk stratification for recurrence,postoperative Tg level,levothyroxine dose,and^(131)I treatment are all predictors of recurrence and metastasis occurring after TSH suppressive therapy failure for DTC,and the developed column line graph prediction mode

关 键 词：甲状腺癌 分化型 促甲状腺激素 预测因子 复发转移 列线图 

分 类 号：R736.1[医药卫生—肿瘤]