分化型甲状腺癌术后^(131)I治疗疗效及影响因素研究

Efficacy of radioactive iodine remnant ablation treatment and its influencing factors in differentiated thyroid cancer patients after thyroidectomy

目的:探讨分化型甲状腺癌(differentiated thyroid cancer,DTC)术后131碘(131I)清甲治疗疗效及其影响因素。方法:选取行131I清甲治疗、资料完整的229例DTC患者。评判首次131I清甲疗效,比较首次清甲成功与未成功组在年龄、性别、手术方式、病理类型等各指标之间的差异。结果:首次清甲成功率70.74%(162/229),单因素分析显示首次清甲成功组原发癌灶直径、s Tg水平显著低于未成功组,差异有统计学意义(P<0.05);复发危险分层低危组首次清甲成功率高于中危、高危组,差异有统计学意义(P<0.05);无转移组首次清甲成功率高于术后无转移组、术后淋巴结转移组及远处转移组,差异有统计学意义(P<0.005);清甲前s Tg水平预测首次清甲疗效的ROC曲线下面积为0.827,界值为5.35 ng/ml,敏感性为94%,特异性为68.5%,阴性预测值为96.52%。结论:原发癌灶直径、首次清甲前s Tg水平及转移情况是影响清甲疗效的关键因素,首次清甲前s Tg水平是预测清甲疗效的较好指标。

Objective To investigate the rate of successful radioactive iodine remnant ablation after thyroidectomy and its influencing factors.Method229patients with DTC were selected.Assessment of success rate of radioactive iodine remnant ablation and analyzing whether factors such as age,gender,near-total or total thyroidectomy,histological type are difference between successful and unsuccessful remnant ablation groups.Results The successful rate of radioactive iodine remnant ablation was70.74%(162/229).Single factor analysis showed that tumor diameter,preablation sTg were lower in successful radioactive iodine remnant ablation groop than unsuccessful groop(P<0.05);the successful rate is higher in low risk of recurrence group than intermediate and high risk of recurrence groups(P<0.05);the success rate was without metastasis group is higher than that three groups(postoperative without metastasis group,lymph node metastasis group and distant metastasis group(P<0.05);The areas under ROC for sTg to predict unsuccessful ablation was0.827,cutoff value was5.35ng/ml;the sensitivity was94%,the specificity was68.5%,the negative predictive valure was96.52%.Conclusion Tumor diameter,preablation sTg levels,lymph node and(or)distant metastasis are effect factors for ablation of remnant thyroid.Preablation sTg is predictive markers for the effect of remnant ablation.