^(131)I治疗甲状腺乳头状癌伴颈淋巴结转移的短期疗效及与病理特征的关系  

Relationship between the short-term efficacy of^(131)I treatment for papillary thyroid carcinoma with cervical lymph node metastasis and the pathological characteristics

作　　者：刘聪 许翔[2] 郭彦君[1] 王国强[3] 申宝明[4] 赵文娟[1] 李成乾[1] LIU Cong;XU Xiang;GUO Yanjun;WANG Guoqiang;SHEN Baoming;ZHAO Wenjuan;LI Chengqian(Department of Endocrinology and Metabolism,the Affiliated Hospital of Qingdao University,Shandong Qingdao 266000,China;Department of Geriatrics,the Affiliated Hospital of Qingdao University,Shandong Qingdao 266000,China;Department of Nuclear Medicine,the Affiliated Hospital of Qingdao University,Shandong Qingdao 266000,China;Department of Information Management,the Affiliated Hospital of Qingdao University,Shandong Qingdao 266000,China)

机构地区：[1]青岛大学附属医院内分泌与代谢病科,山东青岛266000 [2]青岛大学附属医院老年医学科,山东青岛266000 [3]青岛大学附属医院核医学科,山东青岛266000 [4]青岛大学附属医院信息科,山东青岛266000

出　　处：《现代肿瘤医学》2025年第6期955-959,共5页Journal of Modern Oncology

基　　金：山东省自然科学基金(编号:ZR2022QH127)。

摘　　要：目的:探讨甲状腺乳头状癌(papillary thyroid cancer,PTC)伴颈部淋巴结转移(cervical lymph node metastasis,CLNM)患者术后首次^(131)I治疗的短期疗效及与病理特征的关系。方法:回顾性分析327例PTC伴CLNM患者资料,中位随访时间为8.3个月,根据评估结果分为最佳治疗反应(excellent response,ER)组和非最佳反应(non-excellent response,NER)组。比较2组间临床病理特征,对影响ER的多因素进行Logistic回归分析,评估ps-Tg对ER的预测价值及最佳界值。结果:ER率为58.4%,ER组中原发癌单灶、单侧、最大径≤1 cm、无包膜外侵犯、转移淋巴结最大径<1 cm、数目<5个、ps-Tg<5.66 ng/mL的比率均高于NER组(均P<0.05)。多因素分析显示,仅原发癌单灶、单侧与ER不相关,其余各指标状态均与ER呈正相关(均P<0.05)。ps-Tg与ER关系的ROC曲线下面积(area under the curve,AUC)为0.779,预测ER的最佳界值为7.5 ng/mL,其灵敏度、特异度和准确度分别为75.9%、76.5%和76.1%。结论:^(131)I治疗PTC伴CLNM患者短期内ER率较高;原发灶最大径≤1 cm、无包膜外侵犯、转移淋巴结最大径<1 cm、数目<5个以及ps-Tg<5.66 ng/mL是达成ER的独立影响因素;ps-Tg≤7.5 ng/mL预示达成ER概率较高。Objective:To investigate the relationship between the short-term efficacy for the first postoperative^(131)I therapy in patients with papillary thyroid cancer(PTC)with cervical lymph node metastasis(CLNM)and the pathological characteristics.Methods:A retrospective analysis of 327 patients with PTC with CLNM,with a median follow-up time of 8.3 months,was performed and divided into an optimal treatment excellent response(ER)group and a non-excellent response(NER)group based on the assessment results.Clinicopathological characteristics were compared between the 2 groups,and Logistic regression analysis was performed to evaluate the predictive value of ps-Tg on ER and the optimal cut-off value.Results:The ER rate was 58.4%(191/327).In the ER group,the single primary tumor,the unilateral primary tumor,the maximum diameter of the primary tumor≤1 cm,no extracapsular invasion,the maximum diameter of metastatic lymph nodes<1 cm,the number of metastatic lymph nodes<5,ps-Tg<5.66 ng/mL were higher than those in the NER group(all P<0.05).Multifactorial analysis showed that only primary carcinoma unifocal and unilateral were not correlated with ER,while all the remaining index status were positively correlated with ER(all P<0.05).The area under the ROC curve(AUC)for the relationship between ps-Tg and ER was 0.779,and the optimal cut-off value for predicting ER was 7.5 ng/mL,with the sensitivity,specificity and accuracy of 75.9%,76.5%and 76.1%,respectively.Conclusion:PTC patients with CLNM treated by^(131)I have a higher ER rate in the short term.The diameter of the primary lesion≤1 cm,no extracapsular invasion,the diameter of metastatic lymph nodes<1 cm,the number of metastatic lymph nodes<5,and ps-Tg<5.66 ng/mL are independent risk factors for predicting ER.ps-Tg≤7.5 ng/mL indicates a higher probability of reaching ER.

关 键 词：甲状腺乳头状癌 颈部淋巴结转移 ^(131)I治疗 短期疗效 

分 类 号：R736.1[医药卫生—肿瘤]