持续或复发性分化型甲状腺癌再手术疗效及其影响因素分析  

Analysis of the efficacy and risk factors of reoperation for persistent or recurrent differentiated thyroid cancer

作　　者：田港 汤子媚 洛玉明 黄韬[1] 明洁[1] TIAN Gang;TANG Zi-mei;LUO Yu-ming;MING Jie(Department of Breast and Thyroid Surgery,Affiliated Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院甲乳外科,湖北武汉430022

出　　处：《中国实用外科杂志》2024年第11期1306-1312,共7页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(No.82270830);湖北省自然科学基金项目(No.2022CFB072)。

摘　　要：目的探讨持续或复发性分化型甲状腺癌(DTC)再手术疗效及其疗效欠佳的危险因素。方法回顾性分析2014-01-01——2022-12-30因持续或复发性DTC于华中科技大学同济医学院附属协和医院甲乳外科行再手术治疗的425例病人的临床资料。采用单因素及多因素logistic回归分析病人再手术后疗效欠佳的危险因素并构建列线图模型,用受试者工作特征(ROC)曲线、校准曲线和临床决策曲线评估模型的预测性能。结果末次随访评估时,疾病状态达到完全缓解者185例(43.5%),疗效不确切者110例(25.9%),生化疗效不佳者67例(15.8%),结构性疗效不佳者63例(14.8%)。多因素logisic回归分析结果表明,初次确诊年龄>48岁(OR=1.989,95%CI 0.143~3.461,P=0.015)、体重指数(BMI)>24.0(OR=1.638,95%CI 1.044~2.596,P=0.032)、未合并桥本甲状腺炎(OR=2.226,95%CI 1.341~3.692,P=0.002)、初次手术阳性淋巴结清扫数目(PLN)>11枚(OR=2.342,95%CI1.488~3.685,P<0.001)、初再次手术时间间隔>12个月(OR=1.661,95%CI 1.065~2.591,P=0.025)、再手术前甲状腺球蛋白(Tg)>5.00μg/L(OR=3.216,95%CI 1.965~2.591,P<0.001)以及再手术阳性淋巴结比例(LNR)>26.20%(OR=1.864,95%CI 1.192~2.915,P=0.006)是再手术后病人疗效欠佳的独立危险因素。ROC曲线、校准曲线和临床决策曲线均提示模型有良好的区分度和预测性能。结论影响持续或复发性DTC预后的独立危险因素包括初次确诊年龄>48岁、BMI>24.0、未合并桥本甲状腺炎、初次手术PLN>11枚、初再次手术时间间隔>12个月、再手术前Tg>5.00μg/L和再手术LNR>26.20%。基于上述危险因素构建列线图模型对持续或复发DTC病人的再手术疗效具有一定的预测价值,可为持续或复发性DTC的治疗及随访方案制定提供一定参考。Objective To investigate the efficacy of reoperation and determine the risk factors of suboptimal efficacy in patients who underwent reoperation for persistent or recurrent differentiated thyroid cancer(DTC).Methods The clinical data of 425 patients who underwent reoperation for persistent or recurrent DTC at Tongji Medical College,Huazhong University of Science and Technology,Union Hospital from January 1,2014 to December 30,2022 were analyzed retrospectively.Univariate and multivariate logistic regression analysis were used to identify risk factors for postoperative suboptimal efficacy in patients receiving reoperation and to construct a nomogram model.The receiver operating characteristic curve(ROC),calibration curve and decision curve analysis(DCA)were conducted to analyze the predictive value of the multiple regression model.Results By the time of last assessment,185 patients(43.5%)achieved complete response,110 patients(25.9%)had indeterminate response,67 patients(15.8%)had biochemical incomplete response,and 63 patients(14.8%)had structual incomplete response.Multivariate analysis revealed that age at first diagnosis>48 years(OR=1.989,95%CI 0.143-3.461,P=0.015),BMI>24.0(OR=1.638,95%CI 1.044-2.596,P=0.032),the absence of Hashimoto thyroiditis(HT)(OR=2.226,95%CI 1.341-3.692,P=0.002),primary positive lymph nodes(PPLN)>11(OR=2.342,95%CI 1.488-3.685,P<0.001),interval between first and second procedures>12 months(OR=1.661,95%CI 1.065-2.591,P=0.025),pre-reoperation Tg level>5μg/L(OR=3.216,95%CI 1.965-2.591,P<0.001),and reoperative positive lymph nodes ratio(RLNR)>26.20%(OR=1.864,95%CI 1.192-2.915,P=0.006)were independent risk factors for suboptimal efficacy after reoperation(P<0.05).ROC,calibration curve and DCA demonstrated that the prediction model exhibited favorable discrimination and prediction accuracy.Conclusion The indipendent risk factors for suboptimal efficacy after reoperation include age at first diagnosis>48 years old,BMI>24.0,the absence of HT,PPLN>11,interval between first and second procedures>1

关 键 词：分化型甲状腺癌 复发 再手术 影响因素 治疗反应评估 

分 类 号：R6[医药卫生—外科学]