分化型甲状腺癌术后首次131I治疗后疗效及影响因素分析  

Analysis of the efficacy and influencing factors after the First 131I treatment after surgery for differentiated thyroid cancer

作　　者：陶绍能 葛俊亮 杨继文 陈晓磊 尹惟礼 王莹莹 刘小岑 TAO Shaoneng;GE Junliang;YANG Jiwen;CHEN Xiaolei;YIN Weili;WANG Yingying;LIU Xiaocen(Department of Nuclear Medicine,The First Affiliated Hospital of Wannan Medical College,Wuhu 241001,Anhui,China)

机构地区：[1]皖南医学院第一附属医院核医学科,安徽芜湖241001

出　　处：《中国临床药理学与治疗学》2024年第12期1435-1440,共6页Chinese Journal of Clinical Pharmacology and Therapeutics

基　　金：皖南医学院重点科研基金(WK2023ZZD20);安徽省教育厅自然科学重点项目(2022AH051240);安徽省教育厅自然科学重点项目(2023AH051746);安徽省高等学校科学研究项目(自然科学类)重大项目(2024AH040239)。

摘　　要：目的:探讨分化型甲状腺癌(DTC)术后首次^(131)I治疗后疗效及影响因素。方法:回顾分析皖南医学院第一附属医院核医学科116例DTC患者术后首次^(131)I治疗的临床资料,分析其疗效并对可能影响疗效的因素分别进行单因素分析及多因素Logistic分析,对多因素Logistic分析有意义的刺激性甲状腺球蛋白(ps Tg)和甲状腺球蛋白(Tg)/促甲状腺激素(TSH)比值(TTR)建立受试者工作特征(ROC)曲线分析其诊断满意(ER)效能。结果:DTC患者术后首次^(131)I治疗后3~9个月随访,达到ER者有69.0%(80/116)。单因素分析发现ER与诊断不满意(NER)组在年龄、性别、TSH、TgVR、肿瘤最大直径、淋巴结有无转移、肿瘤双侧性、多灶性及临床分期方面均无统计学差异(P>0.05)。而^(131)I剂量、抑制性甲状腺球蛋白(nsTg)、psTg、Tg V和TTR均有统计学差异(P<0.05)。多因素Logistic分析结果显示psTg和TTR为DTC术后首次^(131)I治疗的独立危险因素,psTg OR为5.950(95%CI 1.437~24.639,P<0.05),TTR OR为4.137(95%CI 1.073~15.947,P<0.05)。ROC曲线分析预测DTC术后首次^(131)I治疗疗效的最佳临界值ps Tg为8.935μg/L,灵敏度为80.6%,特异性为83.6%,Yuden指数为0.64。而TTR预测DTC术后首次^(131)I治疗疗效的最佳临界值为125.72 ng/m IU,灵敏度、特异性分别为80.6%、91.2%,Yuden指数为0.618。psTg和TTR曲线下面积分别为0.839、0.833。DTC患者随访3~9个月后,psTg<8.935μg/L患者达到ER的有90.5%(67/74)。psTg>8.935μg/L患者达到ER的有30.95%(13/42)。相应的TTR<125.72 ng/m IU达到ER的有90.2%(65/72)。TTR>125.72 ng/m IU达到ER的有34.1%(15/44)。结论:DTC术后首次^(131)I治疗疗效显著。psTg和TTR为DTC术后首次^(131)I治疗的独立危险因素,具有重要的疗效预测价值。AIM:To explore the therapeutic efficacy and influencing factors of differentiated thyroid cancer(DTC)after the first postoperative ^(131)I treatment.METHODS:We retrospectively analyzed the clinical data of 116 DTC patients treated with ^(131)I for the first time after thyroid cancer surgery in the Department of Nuclear Medicine of the First Affiliated Hospital of Wannan Medical College,analysed their therapeutic efficacy,and Univariate and multivariate Logistic analyses were performed for the factors that may affect the efficacy of the treatment,respectively,and established ROC curves to analyse the diagnostic and ER efficacy of those with psTg and TTR that had a significant effect on the multifactorial Logistic analyses.RESULTS:In DTC patients who were followed up 3-9 months after the first postoperative ^(131)I treatment,69.0%(80/116)achieved ER.Univariate analysis revealed no statistical significance between ER and NER groups in terms of age,gender,TSH,TgVR,maximum tumour diameter,presence of lymph node metastasis,bilaterality of tumour,multifocality and clinical stage(P>0.05).While ^(131)I dose,nsTg,psTg,TgV and TTR(Tg/TSH ratio)were statistically significant(P<0.05).The results of multifactorial Logistic analysis showed that psTg and TTR were independent risk factors for the first ^(131)I treatment after DTC,with a psTg OR of 5.950(95%CI 1.437-24.639,P<0.05)and a TTR OR of 4.137(95%CI 1.073-15.947,P<0.05).The best threshold value of psTg for ROC curve analysis to predict the efficacy of the first postoperative ^(131)I treatment for DTC was 8.935μg/L,with a sensitivity of 80.6%,a specificity of 83.6%,and a Yuden's index of 0.64.And the best threshold value of TTR for predicting the efficacy of the first postoperative ^(131)I treatment for DTC was 125.72 ng/mIU,with a sensitivity,specificity of 80.6%and 91.2%,and the Yuden index was 0.618.psTg and TTR areas under the curve were 0.839 and 0.833,respectively.psTg<8.935μg/L patients achieved ER after 3-9 months of follow-up in DTC patients(67/74,90.5%).psTg>8.9

关 键 词：分化型甲状腺癌 碘放射性同位素 甲状腺球蛋白 治疗结果 影响因素 

分 类 号：R736.1[医药卫生—肿瘤]