基于2009版美国甲状腺协会指南及2014版中国指南的分化型甲状腺癌术后复发风险分层软件的应用比较

Performance comparison of intelligent recurrence.risk stratification software based on 2009 American Thyroid Association guidelines and 2014 Chinese guidelines for ^131I therapy of differentiated thyroid carcinoma

目的比较2版分化型甲状腺癌（DTC）术后复发风险分层软件（RSS），以更加方便、准确地评估DTC患者的复发风险。方法依据2009版美国甲状腺协会（ATA）指南及2014版中国DTC诊疗指南分别设计RSS1及RSS2，并纳入2013年1月至2016年1月间1 043例就诊于北京协和医院的无转移DTC患者[男386例，女657例；平均年龄（46.4±10.5）岁]，通过ATA疗效评估系统验证其危险分层的合理性。采用χ^2检验分析数据。结果中位随访2年，RSS1的低、中、高危患者复发率分别为2.8%（1/36）、4.7%（34/725）和42.9%（121/282）, RSS2的低、中、高危患者复发率分别为0（0/29）、3.7%（26/698）和41.1%（130/316）。与RSS1相比，RSS2低危组复发率更低，但差异无统计学意义（χ^2＝3.046, P〉0.05），更多的复发患者被分至高危组，但高危组的复发率两者差异无统计学意义（χ^2＝0.082, P〉0.05）。结论RSS1与RSS2复发危险分层软件均能有效预测患者复发风险，RSS2还可将更多复发患者分至高危组。

ObjectiveTo compare two recurrence-risk stratification software （RSS）, which could evaluate the recurrence-risk in patients with differentiated thyroid carcinoma （DTC） intelligently.MethodsBased on 2009 American Thyroid Association （ATA） guidelines and clinical guidelines for ^131I therapy of DTC patients in China （2014）, two RSS （RSS1 and RSS2） were designed. From January 2013 to January 2016, 1 043 non-metastasis DTC patients （386 males, 657 females; average age （46.4±10.5） years） in Peking Union Medical College Hospital were involved to be risk-stratified, and the results were evaluated by ATA response evaluation system. χ^2 test was used to analyze the data.ResultsWith 2 years′ （median） follow-up, the recurrence rates in low, intermediate and high recurrence-risk groups evaluated by RSS1 were 2.8%（1/36）, 4.7%（34/725） and 42.9%（121/282）, and those were 0（0/29）, 3.7%（26/698） and 41.1%（130/316） evaluated by RSS2. The recurrence rate was lower in low-risk group evaluated by RSS2 than that by RSS1, but there was no significant difference （χ^2=3.046, P〉0.05）. More patients with recurrence were divided into high-risk group evaluated by RSS2, but the recurrence rates of 2 high-risk groups evaluated by RSS1 and RSS2 were not significantly different （χ^2=0.082, P〉0.05）.ConclusionRSS1 and RSS2 could predict recurrence-risk effectively, and RSS2 could classify more recurrent patients into high-risk group.