分化型甲状腺癌的复发原因分析及其外周血甲状腺球蛋白mRNA水平的检测

Recurrent reasons and blood thyroglobulin mRNA levels in differentiated thyroid cancer

目的:分析分化型甲状腺癌(DTC)的主要复发原因,以及探讨对患者术后外周血甲状腺球蛋白(Tg)mRNA水平监控的临床意义.方法:回顾1990～2000年间本院收治的36例DTC复发患者,结合临床和病理资料,分析造成其复发的主要原因.并对复发患者的外周血标本进行RT-PCR检测,与随机抽取的50例未复发病例比较各自的Tg表达水平.结果:复发患者中26例首次手术治疗时被作为良性病变,21例行甲状腺局部肿块切除或甲状腺患叶次全切除术,5例甲状腺患侧叶全切除术,肿瘤组织残留率为61.5%(16/26),局部淋巴结转移率为53.8%(14/26).另有10例复发患者,同侧腺叶复发3例,对侧腺叶复发2例,局部淋巴结复发5例.复发患者的外周血标本中,Tg mRNA的阳性率为91.67%,其表达水平明显高于未复发者(P<0.01). 结论:DTC的临床误诊和治疗手术的方式不恰当是造成复发的重要原因;结合患者术后外周血Tg mRNA水平的监控,可及早发现复发病例,争取及时进行手术.

Objective： To study the recurrent reasons and clinical significance of thyroglobulin （Tg） mRNA levels in differentiated thyroid cancer. Methods： Clinicopathologic data of 36 recurrent patients with differentiated thyroid cancer from 1990 to 2000 were analyzed. Blood Tg mRNA levels were measured by RT-PCR in those cases and 50 patients without relapse. Results： Twenty-six patients were diagnosed as benign tumor initially; of them, 21 received local excision or unilateral subtotal thyroidectomy, and 5 unilateral total thyroidectomy. There were 61.5Y00 （16/26） of residual tumor and 53.8% （14/26） of cervical nodal metastasis. In other 10 cases, ipsilateraland contralateral lobe relapse, and nodal metastasis occurred in 3, 2 and 5 cases, respectively. Expression rate of Tg mRNA in recurrent patients was much higher than that in controls （P〈0. 01）. Conclusion： Misdiagnosis and incorrect operation are the main reasons for tumor recurrence in differentiated thyroid cancer. Blood Tg mRNA detection could be helpful in the early diagnosis of recurrent cases.