血清甲状腺球蛋白及促甲状腺素在分化型甲状腺癌预后判断中的意义

The predictive value of serum thyroglobulin and thyrotropin in the prognosis of differentiated thyroid cancer

目的探讨血清甲状腺球蛋白(thyroglobulin,Tg)及促甲状腺素(thyrotropin,TSH)在分化型甲状腺癌预后判断中的意义。方法分化型甲状腺癌患者112例,检测112例患者术前血清Tg和TSH水平。采用Kaplan-Meier生存分析和COX多因素回归模型分析不同病理参数与患者平均总生存期和平均无进展生存期的关系。结果血清Tg≥20 ng/ml和TSH≥2.5 mIU/L的患者其T分期为3/4的比例和淋巴转移率较高(P<0.05),Tg≥20 ng/ml的患者其肿瘤体积显著大于Tg<20 ng/ml的患者(P<0.05),不同TSH水平患者之间肿瘤大小比较差异无统计学意义(P>0.05)。TNM不同分期患者血清Tg和TSH水平比较差异有统计学意义(P<0.05)。Tg≥20 ng/ml和TSH≥2.5 mIU/L的患者5年生存率分别为79.9%和82.8%,无进展生存率分别为71.0%和73.3%,均显著低于Tg<20 ng/ml和TSH<2.5 mIU/L的患者(P<0.05)。肿瘤大小、T分期、淋巴转移、远处转移、Tg水平、TSH水平是分化型甲状腺癌5年生存率的独立危险因素。结论高Tg和TSH水平与分化型甲状腺癌患者不良预后有关。

Objective To investigate the clinical value of serum thyroglobulin and thyrotropin in predicting the prognosis of differentiated thyroid cancer. Method 112 cases with differentiated thyroid carcinoma in our hospital were included in our study. Serum Tg and TSH levels were detected before oper- ation. Clinical and pathological data were collected. Kaplan-Meier survival analysis and COX multivariate regression model were used to analyze the relationship between different pathological parameters and mean overall survival/progression-free survival. Result The proportion of T Stage and the incidence of lymph node metastasis in patients with serum Tg ≥ 20 ng/ml and TSH ≥ 2.5 mIU/L were much higher（ P 〈 0.05）. The tumor volume of the patients with Tg ≥20 ng/ml was significantly larger than the patients with Tg 〈 20ng/ml （P 〈 0.05 ）. But there were no statistical significances in tumor sizes of patients with differ- ent TSH levels （ P 〉 0.05 ）. Different TNM staging patients had difference Tg and TSH serum levels （ P 〈 0.05 ）. 5 years survival rate and progression - free survival rate in patients with Tg≥20 ng/ml and TSH≥ 2.5 mlU/L were respectively 79.9% ,82.8% and 71.0% ,73.3% ,significantly lower than the Tg 〈 20ng/ml and TSH 〈 2.5 mIU/L patients （P 〈 0.05 ）. Tumor size, T stage,lymph node metastasis, distant metastasis,Tg level and TSH level is an independent risk factor for 5-year survival rate of differentiated thyroid cancer. Conclusion High serum Tg and TSH levels in patients with differentiated thyroid carci- noma predicted poor prognosis.