甲状腺乳头状癌术后不明原因甲状腺球蛋白增高患者的预后分析  

Prognostic analysis of unexplained elevated thyroglobulin after papillary thyroid cancer surgery

作　　者：卢承慧 王国强[1] 司增梅 韩娜[1] 李娇[1] 王聪聪[1] 刘新峰[1] 张莹莹[1] 李凤岐 王叙馥[1] Lu Chenghui;Wang Guoqiang;Si Zengmei;Han Na;Li Jiao;Wang Congcong;Liu Xinfeng;Zhang Yingying;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》2024年第6期566-572,共7页Chinese Journal of Metastatic Cancer

摘　　要：目的探讨甲状腺乳头状癌(PTC)术后^(131)I治疗前的刺激性甲状腺球蛋白(ps-Tg)水平增高但无结构性病灶的患者经^(131)I治疗后的短期及长期治疗反应及其影响因素。方法回顾性分析2016年4月至2019年7月在本院首次行^(131)I治疗的ps-Tg>10μg/L且不伴结构性病灶的PTC术后患者172例,观察^(131)I治疗后的短期及长期治疗反应,比较不同治疗反应组之间的临床病理特征,Logistic回归分析影响治疗反应的因素,采用受试者工作特征曲线分析甲状腺球蛋白(Tg)预测治疗反应的界值。结果172例患者中不同复发风险组之间的Tg增高的原因归类及短期治疗反应占比不同(均P<0.05)。多因素分析显示N 1b期(OR=5.814)、Ⅱ或Ⅲ期(OR=4.242)为预测结构性疗效不佳的独立危险因素,半年后的抑制性Tg水平(OR=2.270)、N_(1b)期(OR=2.409)为预测疗效不佳的独立危险因素。预测疗效不佳的抑制性Tg界值为0.585μg/L。结论对于PTC术后不明原因Tg增高的患者,N_(1b)期、Ⅱ或Ⅲ期、半年后的抑制性Tg>0.585μg/L为预测不良治疗反应的危险因素。Objective To investigate the short-and long-term treatment responses and the influencing factors after radioiodine(^(131)I)adjuvant therapy(RAT)in papillary thyroid carcinoma(PTC)patients with elevated preablative stimulated thyroglobulin(ps-Tg)before^(131)I treatment but without structural lesions after PTC surgery.Methods A retrospective analysis was conducted on 172 PTC patients who underwent initial^(131)I therapy with ps-Tg>10μg/L with no structural lesions from April 2016 to July 2019.The short-and long-term treatment responses were observed,and the clinical and pathological characteristics were compared between different treatment response groups.Logistic regression was used to analyze factors affecting treatment responses,and receiver operating characteristic curve was employed to determine the cutoff value for Tg in predicting treatment responses.Results Among the 172 patients,significant differences in the causal categorization of elevated Tg,as well as the proportions of short-term treatment responses,were found among different recurrence risk groups(all P<0.05).Multivariate analysis revealed that N_(1b)(OR=5.814)and stageⅡ/Ⅲ(OR=4.242)were independent risk factors for structural incomplete response,while suppressed Tg 6 months post RAT(OR=2.270)and N_(1b)(OR=2.409)were independent risk factors for incomplete response.The predictive cutoff value of suppressed Tg for incomplete response was 0.585μg/L.Conclusion For postoperative PTC patients with unexplained elevated Tg,N_(1b),stageⅡ/Ⅲ,and suppressed Tg(6 months post RAT)>0.585μg/L were identified as risk factors for poor treatment responses.

关 键 词：甲状腺肿瘤 甲状腺球蛋白 预后 

分 类 号：R73[医药卫生—肿瘤]