首次131Ⅰ治疗前刺激性Tg对分化型甲状腺癌转移的预测价值

Predictive value of stimulated thyroglobulin for metastases from differentiated thyroid carcinoma be-fore the first 131Ⅰtreatment

目的探讨分化型甲状腺癌(DTC)患者术后首次131I治疗前刺激性甲状腺球蛋白(sTg)与转移部位、转移灶数目和直径的关系,评估其对不同部位转移的预测价值.方法选取2012年1月至2017年6月行首次131Ⅰ治疗的DTC患者567例[男179例,女388例,年龄(45.3±12.3)岁],治疗前1周内查血清甲状腺球蛋白抗体(TgAb)、sTg、促甲状腺激素(TSH).根据影像学检查和病理结果判断患者有无转移,通过Kruskal-WallisH检验比较不同部位转移组间以及不同转移灶数目、直径组间sTg的差异;对转移灶数目、直径与sTg水平的关系进行Spearman相关分析;采用受试者工作特征(ROC)曲线分析首次131I治疗前sTg对DTC转移的预测价值.结果首次131I治疗前骨、肺、淋巴结转移组及无转移组sTg中位值分别为500.00、104.40、27.45、2.39μg/L,除骨转移与肺转移组比外,其余组间比较差异有统计学意义(H值:-294.605~175.162,均P<0.05).肺及淋巴结转移组中转移灶数≥3、=2、=1亚组的sTg水平均依次降低(H值:-57.887~48.763,均P<0.05).肺及淋巴结转移组中>2.0cm、1.1~2.0cm、≤1.0cm亚组的sTg水平同样均依次降低(H值:-69.935~61.043,均P<0.05).肺及淋巴结转移灶数目和直径均与sTg呈正相关(rs值:0.568、0.606和0.806、0.664,均P<0.05).骨转移、肺转移及淋巴结转移组sTg的ROC曲线下面积分别为0.935、0.843、0.791;最佳界值点分别为197.65、23.21、10.96μg/L,灵敏度分别为91.70%、79.60%、67.20%,特异性分别为97.20%、80.80%、82.70%.结论首次131I治疗前sTg水平对判断DTC有无转移、转移部位、转移灶数目和直径均有一定的预测价值.

Objective To explore the relationship between the stimulated thyroglobulin ( sTg) and site, number and diameter of metastatic lesions in patients with differentiated thyroid carcinoma (DTC) before the first 131 I treatment, and to evaluate the predictive value of sTg for different metastatic sites. Methods A total of 567 DTC patients (179 males, 388 females;age: (45.3±12.3) years) who received the first 131Ⅰ treatment between January 2012 and June 2017 were included. Thyroglobulin antibody (TgAb), sTg and thyroid stimulating hormone ( TSH) were determined within 1 week before 131 I treatment. Metastases were detected by ultrasonography, CT or 18 F-fluorodeoxyglucose ( FDG ) PET/CT, 131 I whole-body scan, SPECT/CT imaging and pathology. sTg levels of patients with different metastatic sites and different metasta-sis numbers or lesion diameters were compared ( Kruskal-Wallis H test) . Spearman correlation analysis was performed on the number, diameter and sTg level of metastases. The receiver operating characteristic ( ROC) curve was used to explore the predictive value of sTg before the first 131 I treatment for DTC metasta-sis. Results The median values of sTg in the bone, lung, lymph node metastases groups and non-metasta-sis group were 500.00, 104.40, 27.45, 2.39μg/L, respectively, and there were significant differences, ex-cept for bone and lung metastases groups ( H range: -294.605 to 175.162, all P<0.05) . The sTg levels of lung metastasis group and lymph node metastasis group were both decreased by the order of metastasis num- bers (≥3, =2, =1;H range:-57.887 to 48.763, all P<0.05) . As to the diameter of metastases, the sTg levels of >2.0 cm, 1.1-2.0 cm, and≤1.0 cm subgroups in the lung metastasis group and lymph node me-tastasis group were also decreased in order ( H range: -69.935 to 61.043, all P<0.05) . Spearman correla-tion analysis showed that the number ( rs=0.568, 0.606) and diameter ( rs=0.806, 0.664) of the metasta-ses in the lung and lymph node metastases group were positively correlated with sTg (all P<0.05). Areas under ROC curves for sTg to predict bone, lung and lymph node metastasis were 0.935, 0.843 and 0.791 re-spectively. The threshold values were 197. 65, 23. 21 and 10. 96 μg/L respectively. The sensitivities and the specificities were 91.70%, 79.60%, 67.20% and 97.20%, 80.80%, 82.70% respectively. Conclusions Tg level before the first 131 I treatment has a certain predictive value for the metastasis, metastatic site and num-ber or diameter in DTC patients.