术前甲状腺球蛋白水平与甲状腺乳头状癌严重程度的关系

Relation of preoperative serum thyroglobulin concentration and aggressive behavior of papillary thyroid cancer

目的探讨甲状腺乳头状癌（papillary thyroid cancer，PTC）患者术前血清甲状腺球蛋白水平（强）与疾病严重程度之间的关系。方法回顾性研究南京医科大学附属淮安第一医院甲状腺乳腺外科2013年1月至2017年12月经手术病理确诊PTC患者334例，通过矿检验比较Tg高水平组及低水平组临床参数间关系。通过Logistic回归分析影响PTC患者甲状腺外侵袭及淋巴结转移的危险因素。结果强高水平组的年龄、多发病灶、肿瘤最大直径、甲状腺外侵袭、淋巴结转移、T分期及TNM分期均显著高于低水平组（P〈0．05）。肿瘤最大直径〉2cm（P=0．031）和术前血清Tg水平〉17．21ng／ml（P=0．028）为预测甲状腺外侵袭的独立危险因素。女性为淋巴结转移的保护性预测因素（P〈0.001），肿瘤最大直径〉2cm（P=0.007）和术前Tg〉25．40ng／ml（P=0．016）为预测淋巴结转移的独立危险因素。结论术前血清Tg水平可作为PTC患者合并甲状腺外侵袭和淋巴结转移的独立危险因素，在一定程度上有助于预测甲状腺疾病严重程度。

Objective To evaluate the association between preoperative serum thyroglobulin concentration and aggressive behavior of papillary thyroid cancer（PTC）. Methods A total of 334 PTC patients diagnosed by surgical pathology treated in our hospital from Jan. 2013 to Dec. 2017 were retrospectively reviewed. Patients were divided into two groups according to Tg levels and clinicopathological characteristics between the two groups were compared. Binary logistic regression analysis was conducted to evaluate the factors influencing extrathyroidal extension and lymph node metastasis of PTC. Results High level of preoperative serum Tg was signifcantly associated with old age, muhifocality, larger maximum tumor size, more frequent extrathyroidal extension, lymph node metastasis, and advanced T and TNM stage （P〈0.05）. Maximum tumor diameter 〉2 em（P=0.031 ） and preoperative serum Tg level 〉17.21 ng/ml （P=0.028） were independent risk factors for extrathyroidal extension. Maximum tumor diameter 〉2 era（P=0.007） and preoperative serum Tg levels 〉25.40 ng/ml （P=0.016） were independent risk factors for lymph node metastasis, whereas female was a significant protective predictive factor（P〈0.001 ）. Conclusion Preoperative serum Tg levels may serve as an independent risk marker for extrathyroidal extension and lymph node metastasis of PTC, and partly contributes to predict aggressive behavior of PTC.