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动态监测^(131)I治疗前刺激性Tg在DTC远处转移诊治中的增益效应 被引量:5

The Incremental Effect of Dynamically Tracing Pre-ablation Stimulated Thyroglobulin in the Diagnosis and Treatment for Distant Metastasis in Differentiated Thyroid Cancer
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摘要 [目的]探讨动态监测131I治疗前刺激性甲状腺球蛋白(s Tg)在伴有远处转移的分化型甲状腺癌(DTC)诊治中的意义。[方法]221例甲状腺全切或次全切术后拟行131I治疗的DTC患者,根据是否存在远处转移分为M1组(50例)和M0组(171例)。动态监测131I治疗前s Tg及相应促甲状腺激素(TSH)水平(首次测量值记为Tg1、TSH1,末次记为Tg2、TSH2)。分别计算s Tg变化值(△Tg)及其变化速度(v Tg)、Tg/TSH变化值(△Tg’)及其变化速度(v Tg’),以及s Tg随TSH变化比值(△Tg/△TSH)。将以上各s Tg变化指标分别与Tg1、Tg2结合,建立Logistic回归方程,并用ROC曲线及最佳诊断界值点(DCP)评估各指标单独及联合应用在判断远处转移性DTC的价值。[结果]s Tg变化指标中,△Tg/△TSH对远处转移性DTC的诊断更有价值,界值范围为-0.40~0.44ng/μIU,对应灵敏度、特异性、准确率分别为90.00%、88.89%和89.14%。△Tg/△TSH结合s Tg水平(Tg1或Tg2)联合判断DTC远处转移的ROC曲线下面积(AUC)可达0.971,特异性93.57%,准确率92.31%,较两者单独应用时均有提高。[结论 ]131I治疗前动态监测s Tg对伴有远处转移DTC的诊疗具有增益效应,s Tg随TSH变化比值(△Tg/△TSH)与s Tg水平结合有助于提高DTC远处转移诊断的准确率和特异性,为DTC 131I治疗前评估及治疗策略的制定提供依据。 [Purpose] To investigate the value of dynamically tracing pre-ablation stimulated thyroglobulin(s Tg) in the diagnosis and treatment for differentiated thyroid cancer(DTC) with distant metastasis. [Methods] The 221 cases with DTC undergoing total or subtotal thyroidectomy were divided into 2 groups:M1(n=50) and M0(n=171) according to the presence or absence of distant metastases. Pre-ablation s Tg and the corresponding thyroid stimulating hormone(TSH) values were dynamically surveilled. The pre-ablation s Tg and corresponding TSH collected at the first time were marked as Tg1 and TSH1,while as Tg2 and TSH2 at the last time. Variation indexes including pre-ablation s Tg variation(ΔTg) and its velocity(v Tg),Tg/TSH variation(ΔTg') and its velocity(v Tg'),as well as ΔTg/ΔTSH ratio were calculated. Logistic regression equation was established based on the above variation indexes combining with Tg1 and Tg2,respectively. All of the indexes,independent or combined were compared by receiver operating characteristic(ROC)curves and diagnostic critical point(DCP) to evaluate their value in judging distant metastasis of DTC. [Results] Among all of the s Tg variation indexes,ΔTg/ΔTSH,whose reference range was-0.40~0.44ng/μIU,worked best in judging distant metastasis of DTC with sensitivity of 90.00%,specificity of 88.89%,and accuracy of 89.14%. The area under the ROC curve of ΔTg/ΔTSH combining with either of pre-ablation s Tg(Tg1 or Tg2) in judging distant metastasis was 0.971.This combination,compared with each of the independent indexes,helped improve the accuracy to 92.31% with a higher specificity(93.57%). [Conclusions] Dynamically tracing s Tg before radioiodine therapy might offer more incremental effect to the diagnosis and treatment for distantmetastasis in DTC. Combining ΔTg/ΔTSH with either of pre-ablation s Tg(Tg1 or Tg2) would be helpfull to improve the accuracy and specificity of judging distant metastasis in DTC patients as well as providing evidence for pre-ablative assessment and strategies of radioiodine treatment.
出处 《肿瘤学杂志》 CAS 2015年第6期459-464,共6页 Journal of Chinese Oncology
基金 卫生行业科研专项项目(201202012) 国家自然科学基金(30970850)
关键词 分化型甲状腺癌 甲状腺球蛋白 131I治疗 诊断 differentiated thyroid cancer thyroglobulin radioiodine therapy diagnosis
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参考文献15

  • 1Bethesda MD. SEER cancer statistics faclsheels:thyroid cancer. Nalional Cancer lnslitute[OI,], hllp://seer.can~'er. gov/statfacls/html/thyro.html, 2014- l 1 - 15.
  • 2Nixon lJ,Whitcher M,Palmer FL,et al. The impact ofdistant metastases at presentation on prognosis in patients with differentiated carcinoma of the thyroid gland[J].Thy- roid, 2012,22(9) : 884-889.
  • 3Lee J, Soh EY. Differentiated thyroid carcinoma presenting with distant metastasis at initial diagnosis clinical out- comes and prognostic factors[J]. Ann Surg, 2010,251 (1) : 114-119.
  • 4Cooper DS,Doherty GM,Haugen BR,et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid, 2009,19(I 1): 1167-1214.
  • 5GonzOlez C,Aulinas A,Colom C,et al. Thyroglobulin as early prognostic marker to predict remission at 18-24 months in differentiated thyroid carcinoma[J]. Clinical En- docrinology, 2014,80(2) : 301-306.
  • 6Ciappuccini R,Hardouin J,Heutte N,et al. Stimulated thyroglobulin level at ablation in differentiated thyroid cancer:the impact of treatment preparation modalities and tumor burden[J]. Eur J Endocrinol, 2014,171(2) : 247-252.
  • 7Makarewicz J,Adamczewski Z,Knapska-Kucharska M, et al. Evaluation of the diagnostic value of the first thy- roglobulin determination in detecting metastases after dif- ferentiated thyroid carcinoma surgery[J]. Exp Clin En- docrinol Diabetes, 2006,114(9) : 485-489.
  • 8李田军,林岩松,梁军,李小毅,邱李恒,王莎莎,陈永辉,康增寿,李方.^131I治疗前刺激性Tg对乳头状甲状腺癌远处转移的预测价值[J].中华核医学与分子影像杂志,2012,32(3):189-191. 被引量:47
  • 9甲状腺结节和分化型甲状腺癌诊治指南[J].中华内分泌代谢杂志,2012,28(10):779-797. 被引量:678
  • 10Sub I,Vriens MR,Guerrero MA,et al. Serum thyruglobu- lin is a poor diagnostic biomarkcr of malignancy in follicu- lar and Hurthle-eell neoplasms of the thyroid[J]. Am J Surg, 2010,200(1) :41-46.

二级参考文献14

  • 1ZHURui-sen YUYong-li LUHan-kui LUOQuan-yong CHENLi-bo.Clinical study of 312 cases with matastatic differentiated thyroid cancer treated with large doses of ^(131)I[J].Chinese Medical Journal,2005(5):425-428. 被引量:10
  • 2American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer,Cooper DS,Doherty GM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J].Thyroid:Official Journal of the American Thyroid Association,2009.1167-1214.
  • 3Giovanella L. Highly sensitive thyroglobulin measurements in differentiated thyroid carcinoma management[J].Clinical Chemistry and Laboratory Medicine,2008.1067-1073.
  • 4Salvatori M,Raffaelli M,Castaldi P. Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma[J].European Journal of Surgical Oncology,2007,(5):648-654.doi:10.1016/j.ejso.2007.02.034.
  • 5Makarewicz J,Adanczewski Z,Knapska-Kucharska M. Evaluation of the diagnostic value of the first thyroglobulin determination in detecting metastases after differentiated thyroid carcinoma surgery[J].Experimental and Clinical Endocrinology & Diabetes,2006,(9):485-489.doi:10.1055/s-2006-951778.
  • 6Sampson E,Brierley JD,Le LW. Clinical management and outcome of papillary and follicular (differentiated) thyroid cancer presenting with distant metastasis at diagnosis[J].Cancer,2007.1451-1456.doi:10.1002/cncr.22956.
  • 7Suh I,Vriens MR,Guerrero MA. Serum thyroglobulin is a poor diagnostic biomarker of malignancy in follicular and Hurthlecell neoplasms of the thyroid[J].American Journal of Surgery,2010.41-46.doi:10.1016/j.amjsurg.2009.08.030.
  • 8Phan HT,Jager PL,van der Wal JE. The follow-up of patients with differentiated thyroid cancer and undeteetable thyroglobulin (Tg) and Tg antibodies during ablation[J].European Journal of Endocrinology,2008.77-83.doi:10.1530/EJE-07-0399.
  • 9Tourniaire J,Bernard MH,Ayzac L. Serum thyroglobulin assay after total unilateral thyroid lobectomy for differentiated thyroid cancer[J].Presse Medicale,1990.1309-1312.
  • 10张桂芝,谭建,刘雪辉,孟召伟.131I治疗分化型甲状腺癌术后患者疗效影响因素研究[J].中华核医学杂志,2010(4):259-263. 被引量:44

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