甲状腺乳头状癌甲状腺球蛋白抗体的动态监测及其预后价值

Dynamic changes of thyroglobulin antibody and its prognostic value for papillary thyroid carcinoma

目的探讨甲状腺球蛋白抗体(TgAb)阳性(+)甲状腺乳头状癌(PTC)患者TgAb变化规律及其与患者预后的关系。方法回顾性分析2008年2月至2014年12月间PTC术后行放射性^131I治疗(RAI)的817例患者(男254例、女563例,中位年龄45岁)。RAI前TgAb(+) 130例,TgAb阴性(-)687例。分析RAI后3年间TgAb变化,并得出预测疾病复发和(或)转移的TgAb下降百分比阈值。采用Mann-Whitney u检验、X^2检验和受试者工作特征(ROC)曲线分析处理数据。结果TgAb(+)及TgAb(-)组患者,在性别、是否合并桥本甲状腺炎(HT)、危险度分层及是否复发和(或)转移间的差异均有统计学意义(X^2值:13.988~191.059,2=2.053,均P<0.05)。有、无复发和(或)转移的TgAb(+)患者在肿瘤大小、是否腺外侵犯、危险度分层、RAI前TgAb及是否合并HT方面的差异均有统计学意义(X^2值:3.865~6.278,z值:4.624和3.641,均P<0.05)。有、无复发和(或)转移的TgAb(-)患者在肿瘤大小、是否腺外侵犯、危险度分层及TNM分期方面的差异均有统计学意义(X^2值:13.459,8.215,z 值:5.385、3.998,均 P<0.05)。ROC 曲线分析示,TgAb(+)患者 RAI 后 1、2和3年预测复发和(或)转移的TgAb下降百分比阈值分别为54.0%.38.0%和59.0%,曲线下面积分别为0. 847,0.815和0.822。结论 RAI后TgAb的变化趋势与预后有关;RAI后1、2、3年TgAb分别下降≥54.0%、≥38.0%和≥59.0%的PTC患者预后较好。

Objective To investigate the change of thyroglobulin antibody (TgAb) level in patients with TgAb-positive papillary thyroid carcinoma (PTC), and explore the relationship between the variation of TgAb level and prognosis. Methods A total of 817 PTC postoperative patients (254 males, 563 females, median age 45 years) who underwent radioactive iodine therapy (RAI) from February 2008 to December 2014 were retrospectively analyzed. There were 130 patients with TgAb (+), and 687 patients with TgAb (-).The dynamic changes of TgAb in 3 years after RAI were observed, and the threshold value of TgAb reduction rate in predicting recurrence/metastasis was plotted. Mann-Whitney u test,X^2 test and receiver operating characteristic (ROC) curve analysis were used to analyze the data. Results There were statistically significant differences in gender, concurrent with Hashimoto thyroiditis (HT), risk stratification and recurrence/metastasis between TgAb (+) and TgAb (-) groups (X^2 values: 13.988-191.059, z=2. 053, all P<0. 05). There were statistically significant differences in tumor size, extrathyroidal extension, risk stratification ,TgAb before RAI and concurrent with HT between TgAb (+) patients with and without recurrence/metastasis (X^2 values: 3.865-6.278;z values: 4.624, 3.641, all P<0.05). There were statistically significant differences in tumor size, extrathyroidal extension, risk stratification and TNM staging between TgAb (-)patients with and without recurrence/metastasis (X^2 values:13.459, 8.215, z values: 5. 385, 3.998;all P<0.05). For patients with TgAb (+), the optimum cut-off threshold of TgAb reduction rate in predicting recurrence/metastasis by ROC curve analysis at 1, 2 and 3 years after RAI was 54.0%, 38.0% and 59. 0%, respectively, and the corresponding area under the curve (AUC) was 0.847, 0.815 and 0.822, respectively. Conclusions The trend of the TgAb after RAI is related to the prognosis of patients. Patients with TgAb decreased ≥54.0%,≥38.0%,≥59.0% after 1,2,3 years post-RAI may have better prognosis.